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HomeMy WebLinkAboutCLE201200133 Legacy Document 2012-07-12Application forZoninp Clearance. CLE # PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # 2 -6 ( Date: lJ Receipt # ( Staff: PARCEL INFORMATION Tax Map and Parcel: Q Q 5 CO -03 -04 Y60 a© Existing Zoning Parcel Owner: bYuGfe vas'/ be- t'aS ZL e RSS©C PLC ParcelAddress:l06 90,y4eyls old .su;ie '-/Do CitycV1a (lAesyille State V A zip 2211%6 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? i �V Q /Dl /Z�f Address : qoo ea (d,-4 f / �)/d sulk �OU City C-4g K /a%ir-sl -�11c State y lq- ZiP 2.229d Office Phone: ( Y) ZDZ -/q36 Cell # �/N- ZW-320­Fax # E -mail f e l ; X key-b4) I ^� Q y�[ 400 APPLICANT INFORMATION Check any that apply: Change of ownership of use Change of name New business / ,Change Business Name /Type: &a I5' Su /O �'/ /AkL 1- .5/ ,L //'.S Previous Business on this site L— /? V/ J-10 n DF 6V ar lo *Y- esv %`le Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: I�al re&] , 1-1'4 r ('o /d4+i-/, S/v // inn IVY! i11 fe *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to jh owled e>I have read the conditions of approval, and I understand them, and that I will abide by them. Signature G Printed APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official �- Date G Zoning Official 6 Date e'A, Z-L Other Official Date County of Albemarle Department of Uommun►ty lieveiopment 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 Cot; Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /N Will sere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE Circle the one that applies Is parcel on private well or public water? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ] c 6 kc t✓u e Circle the one that applies Is parcel on septic or public sewer? VN `((Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Z Y/N ill there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7.nninn fn nmmnlafa Ap fnllnwina' Reviewer to complete the following: Square footage of Use: /0 70 s l Ff 0 erN mitted as: 5 / r j Under Section: —) Supplementary regulations section: Parking formula: Required spaces: Y/ Items o be verified in the field: Inspector : Date: Notes: Violations: Y/O If so, List: Proffers: Y /ITT If so,`EIIst: Vari ce: Y/ If so, List: SP's. If so,Oist: Clearances: SDP's Revised 7/1/2011 Page 3 of 3