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HomeMy WebLinkAboutCLE200900064 Legacy Document 2012-08-30Application for Zonin Clearance' I �ItGINIp' ❑ Zoning Clearance = $35 OFFICE USE ONLY Check # 14 111!9 Date: PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: V13 PARCEL INFORMAT ON y Tax Map and Parcel: 0 300 -©0 -00 — 00 0 Existing Zonin�— �(f�'(jI `,( ilo j Parcel Owner: // Parcel Address: 22i� / (7 8/' ��� City dell e State Zip �gm/ (include suite or floor) PRIMARY CONTACT an Who should we�c+all/ concerning this project.) 5"V � ( /write >' Address : W LIff %G /�/ 6 I? City ? . //il 19d- State Zip Office Phone: 1r3!6 �' / Cell# Fax E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use of name New business /C►hange /� Business Name/Type: /' � � / — /' e/] 0111 IA M- Pd Previous Business on this site i/Q.C4hf /['h('L Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that ou can provide: ,/%G/► /n %��e'1�iG'� .0 -4/ ' y *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 o knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. 11A Signature Printed APPROVAL NFORMATION [ ] 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 C( 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 Intake to complete the following: Y / Is us n LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y/N ill there be food preparation? if so, give applicant a Health Depar nt form. Zoning review can not begin until w ceive approval from Health Dept. FAX DATE Circle the one that ap ies Is parcel on priv well or public water? If private well rovide Health Department form. Zoning revie not begin until we receive approval from Health Dept. FAX DATE Circle the one that plies Is parcel on septi or public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. -7 Permit # Y/N Will there be any new construction or renovations? If so, obtain the p • per Permit. Permit # Zoning to complete the following: Reviewer to complete the following: S/quare footage of Use: 11111 '15111, Under Section: Supplementary Parking formula: Required spaces: Y/N l� Items to be verified in the field: Inspector : Date: Notes: Viol 'ons: Y/ If s , List: Pro Y If t: Varia ce: Y/ If s , ist: SP's: /N so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3