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HomeMy WebLinkAboutCLE200900046 Legacy Document 2012-08-27Application for Zoning Clearance CLE # Z C)Qc-7 — 44 e, U m `lROIN�P 941 oning Clearance = $35 OFFICE USE ONLY Check # iO ©Zk Date: �" Z • [)% PLEASE REVIEW ALL 3 SHEETS Receipt # 7150 a Staff: PARCEL INFORMATION _ Tax Map and Parcel: 0,5& ,9 - 61 -0Q - 00,4/-7 0 Existing Zoning 0oz.u1y4oL y /V Cro �� Parcel Owner:— /,y on IV +� �i 9 (.. Parcel Address: °7c) 3 S!q City State Vex-- (include suite or floor) PRIMARY CONTACT q i l r Who should we call /write concerning this project? L `) Ul e-H e 1.--4 (,l� I u v P-1 \ , Address : 213 .w � N�.ai n S-i^ City ((y � � Iljz C I � V State VA Zip � b � Office Phone: 9 M-5) WZCell # 531' �­L834 Fax # E -mail L-y-e ( (e \j �,� 6�� e , J APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: I " l U I� Previous Business on this site VA Uu, G hzaly- 1(e .S 'So, y )r e h e i J 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:. n I o uiz {' Cfs lwl& a� s S Oe I 5 xrf!= *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 infonnation provided is true and acdurate 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 ���� 1/� Printed APPROVAL INFORMATION iApproved as proposed [ ] Approved with conditions [ ] Denied r] Bacicflow 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 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 11 5/ to complete the following: Y Is An LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Yi/ N Will 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 3 -2- , -O% rekY-,2 �— 31z, o ct Circle the one that applies Is parcel on private well or public water? 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 or public sewer? Y/N Will you be putting up a new sign of any land? If so, obtain proper Sign permit. AJ O Permit # U `` N Will there be any new construction or renovations? If so, obtain•the proper Permit. Permit# Z6)CQ-- q)'"7/9C_ Zoning to complete the following: Reviewer to complete th/e_ following: Square footage of Use: Permitted as: Pit/ —* .. ( Pi I t sky bey Under Section: fQ 8 . h 3j. Supplementary regal t' n section: Parking formula: A- ( Required spaces: Y/N Items to be verified in the field: Violations: Y/N If so, List: Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3