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Home My WebLink AboutCLE200900052 Legacy Document 2012-08-29f3 j-0621_ Ct81A � Application for Zoning Clearance �� °;` CLE # 02 DU q - 7 x; �!1#c;IN�P ❑ Zoning Clearance = $35 OFFICE USE ONLY ' Check # a Date: PLEASE REVIEW ALL 3 SHEETS Receipt # % `f 6 q Staff: PARCEL INFORMATION Z 6j -- b Existing Zoning Tax Map and Parcel: (%aj ©O11 —,, �� "0�'-- Parcel Owner: C16 W Parcel Address: r7.SCatMw�KK��✓ Sd, S�t;�e_ �9 City G{1a.r, © esv ILState V A Zip qcl l (include suite or floor) �� vt y C e✓ PRIMARY CONTACT A tot/el Who should we call /write concerning this project? ad ,q Address: 4 7 7 �9 5, t ae- Rio' a e 4 4 City god e State Zip �,x ng Office Phone: Cell # y3y- 531 -36 '/0 Fax # E -mail iAe 1p 4d J 9G1na� %cc� -w. APPLICANT INFORMATION Check any that apply: Change of ownership Change of use -Change of name New business Business Name /Type: Loyd � yus o -,Girl► ca, /1 q e L1 C 5/ z A l I �ia 4e Previous Business on this site R VCA h /-1ovvAfs Describe the proposed business including use, number of employees, number of I ifts, available parking spaces, number of vehicles, and an}v addi1tion_aIl information that you can provide: pwJ; rt e_ VC,n S ysnrt h c Z c'�i�c.cs `2t2 9LI.slole G(inals *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 i iy kno ledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature J) G Printed Mee) tr7 Gt d 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 /-t-, Zoning Official ° Date S 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: > Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y 6 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 Circle the one that applies Is parcel on private well or p� bli�wac r? If p rivate well, provide Healt �eat form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applie- Is parcel on septic oar publics r? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the properMe it. Permit # 2c>3 9-' '� GG ZoninLy to complete the following: Reviewer to complete the following: Square footage of Use: (,y 6/N Permitted as: �r�� <a .� �4 % oil tai Under Section: Supplementary regulations section: Parking formula: Required spaces: Y/ Items to be verified in the field: Inspector : Date: Notes: Violations: O /N If so, List: U � �� — vyse,�l Proffers: /N f so, List: eft "66–•7 6 9.6- 0- a•7 25t —/% Vari ce: Y /(51 If so, List: P's: /N If so, List: 65-51 Clearances: 4<71-- SDP's 6 C— z-,e air A-7 Revised 04/28/08 Page 3 of 3