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Home My WebLink AboutCLE201200126 Legacy Document 2012-07-13- - -- -- -----Application -for- Zoning Clearance.___ . Cti llp dl /fF.�i OFFICE ., PLEASE REVIEW ALL 3 SHEETS Checic # Date: %�� Receipt # 7 Staff: PARCEL INFORMAT .� 1ON Tax Map and Parcel: iil li1i. D xisting Zoning +v�� - ( N A0 Parcel Owner- 0 DA 14 Y 1r1� I 1W Parcel Address: 3 3 _he_ SfE, b City Q_I'1GY jc) r4eC 1 /Mate IJ A Zip 2-)-9 (include suite or floor) PRIMARY CONTACT AID, I �Q I a Who should we call /write concerning this project? B)" C_ rya, Fw Giwnbri (✓ L U%'. City ha a P v State 11A— Zip 2L%0 Address:, Office Phone: "3 /�O a2 Cell # �7 .�9g 'S ax# E -mail JL017netf �Ia1 WVy APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: L' l , � Previous Business on this site 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: (�`1M 11 M lP_t -=— ��le *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 the best of m knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. A Signature e, �''L,9— Printed � Y7Ae_. 9a (a'Yzt -� yI, 9- APPROVAL INFORMATION X 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 pl as of this date. a Notes Building Official Date T I c a Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 n Q}tiv Intake to complete the following: - - - Reviewer to c- omplete the following:- Y N Square footage of Use: 22'i Is uE LI HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. t�q / N Permitted as: rC fa tt Y N ag , a. ( . iV Cued S�(`y Wil th e be food preparation? Under Section: If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept, FAX DATE Circle the one that applies Parking formula: l Is parcel on private well r public water If private well, provide Healt epartment form.. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Y/N Circle the one that applie Items to be verified in the field: Is parcel on septic or ub �sewer? Y N W it ou be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: -7 Y N Notes: Wi ere be any new construction or renovations? If so, obtain the proper Permit. Permit # LJVlllll 1.V a V►la K— &A— a Viol 'ons: Y/N Ifs ist: Proffers: Y/N If so, List: Var' e: Y / If so, st: S 's: Y N so, List; ��r �� S� • Clearances: 0 3 SDP's Revised 7/1/2011 Page 3 of 3 9 tl Application for .honing Clearance CLE 9 or, CE LY PLEASE REVIEW ALL 3 SHEETS Checic # Date, Receipt # Staff: 1 PARCEL INFORM T ON t t t "nI (ym Lrxisting Zoning Hl1 �&. Tax Map and Parcel: 011 � � 1 ParcelOwnerr I 1 j / ) Parcel Addressi 30 Crjg,? k)b�� . 'StE b City �0'k by �g'r<4e a#tnte 1J A Zip 2)9 (include suito or floor) PRIMARY CONTACT l r r Who should Nye cnil /write concerning this project? Address; w 6;r 17bt'1w L City—alka 0 Ur /8tato VA Zip --;_z90 Office Phone: �� "lam cell # 9$-- ''5ax# E -mail b2J o—S1 @, IlAnalIr � - L Y� APPLICANT INFORMATION Cltecic any that Apply; Change of ownership Change of use Change of name New business Business Name/Type: L AA ti r Previous Business on this site 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 provider „ tn�rn 1 /�h�t -taxi P #This Clearance will only be valid on the parcol for which It Is approved, If you change, intensify or move the use to a new location, anew 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 the best of m knowledge. I have read the conditions of approval, and I understand theni, and that I will abide by them. Signature e. an 9 d+2 -Q— Printed B Y7�1te- ! f'z n APPROVAL INFORMATION j/J Approved as proposed [ J Approved wIth conditions [ J Denied [ J Backflow prevention device and /or current test data needed for this site, Contact ACSA, 977 -d'S 11, x1 I7. [ )No physical site inspection has been done for this clearance, Therefore, it is not a determination of coinplianee with the existing site plan, [ ) This site complies with the site plan as of this date, Notes; Building Official Date t �. Zoning Official Date Other Official ��'e� . Date��2��Z� - c;ouncyotAruauiarrr�at,:ir 401 McIntire Road Charlottesville, VA 2 1/ n' r.4a � /�jJja'J�- °� a.r V ol'^', �4. c�m _ \• ��I' � // `/ ,• � � o;F �m4rN ,F ____ — .. o' II l e! 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