Loading...
HomeMy WebLinkAboutCLE201200157 Legacy Document 2012-07-31Application for Zoning Clearance sr�k`'m CLE # 20q- 15-4- 0, ' PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY f ,r7 5, 1 Checli # � Date: G Receipt # 0-1-70'1- Staff: 0 i PARCEL INFORMATIONS j " j�� 00 + ©� � Zoning Tax Map and Parcel: � Existing Parcel Owner: Sex -cu. C,�.nG( IilAl`s1 xifiir�SQQ� Parcel Address: 431D 6brw fbin+ %, Cityl f-bbJrSVi'11e, State YA ZipD02 (include suite or floor) PRIMARY CONTACT Sl ��S Who should we call /write concerning this project? Address: 5« ( [-� �CYtG' City`rb(;Ua"aV��l� State VA zip 2X923 Office Phone: 34 qZ$b Zq7 Cell # 4�4 06(o515q Fax # E -mail cli-s burrls @k {'mad t© j APPLICANT INFORMATION heck any that apply: ✓ Change of ownership Change of use V� Change of name New business Business Name /Type: S+onj Payrx+Ktiv -k.+,+ LLC Previous Business on this site SC yne- Wsir255 ywideG -" GUly`r`e_4 CLMP 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: '° ST Qrec�C �x 2.0 CCIM *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 an a urate to the best o ledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature '� '� Printedt �I G�h11 GJ�V't 15 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 c 1 �1 Zoning Official Date ` A /* Date Other Official County of Albemarle Impartment or t;ommunay LeveiopaieuL 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 1# Intake to complete the following: Y / Is use I, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. 4N there 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 �, 2 Circle the one t t- appl-i s Is parcel o rivate well r public water? If private , ovi e 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 septic r public sewer? Y/N Will you be putting up a new sign of any kind? Sign permit. Permit # Reviewer to complete the following: Square footage of Use: ,%-2-6 a (9 /N L Permitted as: C,iAA,+,/ Under Section: ° I Supplementary regulations section: Farxmg rormuia: Required spaces: ItNI Itei to be verified in the field: If so, obtain proper Inspector : Date: Y / N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7nnina +n nmmn1P +P +17P fnllnwinv! Violations: Y/O If so, List: Proff rs: Y / If so, ist: Variance: Y/1 If soZist: SP's: Y/N If so, List: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 yL VC, co <t--