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HomeMy WebLinkAboutCLE200900011 Legacy Document 2012-08-22Application for Zoning Clearance CLE # Z&? r i © Zoning Clearance = $35 OFFICE USE ONLY �`�� Ile Check # 95 Date: PLEASE REVIEW ALL 3 SHEETS Receipt # Staff. , %G% PARCEL INFORMATION ` 1 Tax Map and Parcel: 9 V) — 1 l Q � Existing Zoning C_ 0 n5 t^ Parcel Owner: Parcel Address: At14snV)& WY" City CxheRrk4AfSkh tie State Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project ?��-�� Address: kGcLQ �Y\ aVVN Cf_1V P1C City �C�O C m— t �1 tate y I rZip Office Phone: � Sell # `ft .qOq 71 -ISFax # a. -mail cla jJi h4eck arp APPLICANT INFORMATION Check any that apply: Change of ownership Change of use of name New business ^� /Change Business Name /Type: -PI '(1, -4:"ar\ ('1 P1 rrl:y1 `C1' 1 `y l-1 -cko C'e>C1-\-°e_(-- Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of ehicles, and any additional information that you can provide: *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. shave read e conditions of approval, and I understand theism, and that I will abide by them. Signature Printed I) „V \ (J� 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, x119. [ ] 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 Zoning Official Date Other Official Date County of Albemarle Department'0 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 n 1 . -es Intake to complete the following: Y N Is t I, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will e 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 G� r? If private well, provide Healt 1fe a form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that apples Is parcel on septic or p is se er? Y/N Will you be puttil up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any 1 w construction or renovations? If so, obtain the pr per Permit. Permit # Zoning to comnlete the following: Reviewer to complete the following: Square footage of Use: 0 b 0/ N Permitted as: I �PJ Under Section: v • �)� I Supplementary regulationsIsection: Parking fornnul Required spaces: 3 Y/N Itet k to be verified in the field: Inspector : Date: Notes: Viola ' ns: Y/ If so, ist: Pro ' ers: Y /N If so, ist: Var�i�aTn�e: YZ If so, List: SP's: Y /ICI If salt: Clearances: I SDP's Revised 04/28/08 Page 3 of 3