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Home My WebLink AboutCLE200900021 Legacy Document 2012-08-27Application for Zoning Clearance U ® C q ❑ Zoning Clearance = $35 OFFICE USE ONLY Check # 11,115 Date: /d PLEASE REVIEW ALL 3 SHEETS Receipt # '� Staff-�� PARCEL INFORMATION/�I� Tax Map and Parcel: VS (MOO Existing Zoning o r Parcel Owner: Parcel Address: City 1, State Zip 1I (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address : 5q7_9 7>F"rnoi)swL.u- City Gt1644,ar%AUL State VA Zip 20965 ��%' S� C A f Office Phone: l ( A Z ©,S ' C� Cell # !� 1J - � Fax # d s ec —E-mail- Ads APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business 'T Business Name /Type: 10 71 -sli2C- tf!Z FK E L� C!!! Grrne oP Previous Business on this site A} tAi t : Ol i t;k_� 4zma i`7r,c ,PME -A !" l 71 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: *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 enITFroWe Jst knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed Avz. a� AP"OVAL INFORMATION [Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 19. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a detennination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date �(_f�I Zoning Official Date 101 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 Intake to complete the following: Y/10 Is use m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. I N ill there be food preparation? If so, give applicant a Health Department form. Zoning review can not begi i unti we receive approval from Health Dept. FAX DATE J '/ Circle the one that applies Is parcel on private well If private well, provide 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 lic sewer? 'VilYTbu be putting up a new sign of any kind? If so, obtain proper Sign Permit.. - Q Y/N ill there be any new construction or renovations? If so, obt e M tw Permit # Zonine to complete the following: Reviewer to complete the following: Square footage of Use: C %'YOWL 0/N Permitted as: (��i' �1P(t ✓�G� (� $-{i,� l Sl- "�tF�c.� Under Section: Supplementary regulations section: Parlc1ngform / t:20 j : Required spaces: �Gcl T%U /v,, tl`� YIN l j Items to be verified in the field: Viol ns: Y / 1 If ist: offers: so, List: o, .h, - rA �Y AJ %