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HomeMy WebLinkAboutCLE200900001 Legacy Document 2012-08-07i V - Applicati ®n f ®r Zoning Clearance U1 � CLE # ! �7(� QI —Z— [x Zoning Clearance = $35 OFFICE USE ONLY Check # )b z D Date: 0 1 0 9 PLEASE REVIEW ALL 3 SHEETS Receipt # % 6 5�� ti Staff: d, PARCEL INFORMATION Tax Map and Parcel: jj 21/4 Existing Zoning(' 1'V101�1 Parcel Owner: ��+p. �,�� ��_� ``'� ,,,,��, C*OL( b•M'Y(50 [kState � Zi �-QL� Parcel Address: ���� � «� -���.� City � P (include suite or flo PRIMARY CONTACT �"" ,,,� pp� MNA kwxm 0•C- Who should we call /write concerning this project? l` �� l J _ r Address : ����i -swo9cre ULA-3— City (jk0V 64SV%WL State- Zip Office Phone: x°13 Cell # Fax # 434om %mE, APPLICANT INFORMATION Check any that apply: Change of ownership Change of use ✓Change of name New business Business Name/Type: O -,coe— 56 dae CM\aVo& c Previous Business on this site A\Ai93n l��iQC�'ilC ° PC 01lw �] 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: C.,k,, O, -C6C*ir ge.S, 0 yQVcJV_5 use& fim 1AJ 5,AR"s i© curl& .0&& *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 /my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature \ y PrintedGt�' 1G�(1 lC�'S61r� ��. AP ROVAL INFORMATION [ YJ Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977-45-1-17.=1719 [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of jd iipl' em hiq and/or lg �leec� site plan. Current�estata j Contact ACSA 977 -4511 ext. 11 [ ] This site complies with the site plan as of this date. Notes: Building Official Date Zoning Official Date 0° 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 04/28/08 Page 2 of 3 C r t, - Intake to complete the following: Reviewer to complete following: Y / N ?the Square footage of Use: J 5S Is US LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Vyel / N / �+ mitted as: �liU�.G SS j 6Y� 111 -P Gr/ Y / _ Wile be food preparation? Under Section: _ If so, give applicant a Health Department form. SP's: Y/� ) If so, ' ist: Zoning review can not begin until we receive approval from Health Supplementary regulations ection: Dept. FAX DATEa Circle the one that applies Is parcel on private well or ublic _.ater� Parking formula: / If private well, provide Healt epartment form. - Zoning review can riof -egiri unfi -we receive approva - om�3ea t -- Dept. FAX DATE - Require spaces: Y/N Circle the one that applies Items to be verified in the field: Is parcel on septic or public sewer? N ill you be putting up a new sign of any kind? If so, obtain proper Sign permit Permit # 'Z�b�j " J qS Inspector : Date: Y / N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Violations: Y/ If so st: _ , , � !l� Proffers: If rM If so ist: 7� Variance: Y/ If so, ist: SP's: Y/� ) If so, ' ist: Clearances: 17 l P4-.e V-. e�Lrvp,r SDP's Revised 04/28/08 Page 3 of 3 Sketch of 103 -A Free Bridge Lane, Charlottesville, VA 22911 Main Floor (Ground Level) appoximately 1 375 square tee.t