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HomeMy WebLinkAboutCLE200900072 Legacy Document 2012-08-30Application for Zoning Clearance °° CLE # �N - ql , 7 ❑ Zoning Clearance = $35 OFFICE USE ONLY Check # Date: PLEASE REVIEW ALL 3 SHEETS Receipt # P',f 7rd� Staff: PARCEL INFORMATION f Tax Map and Parcel: 091A 0 — GYM— Up — ocx>ho Existing Zoning Parcel Owner: Al. n, k,6krwW Parcel Address: We City E 4CUA 5ydtD State zip 936 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? eE50 Address: City r AK V l f State V4 Zip :� Office Phone: OV, Cell # 3IM x777 Fax # E -mail D %p�Z�`U/�% (% / e, -OA-1 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business / Business Name /Type G� 1 �i (J r l Wi/l �I /�j- r,G2Y�1 ��D1rP Previous Business on this site ,,41 (_V6 6 CEVZ?5 Describe the proposed business including use, number of employees, number of shifts, available parking spaces, numb pr of vehicles, and any additio al infgrmation that you can provide: . 7v ® .� 30 *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 th . est of my knowledge. I have read a conditions of approval, and I understand them, and that I will abide by them. Signature Printed o aS© APPROVAL INFORMATION ,[,,-Approved as proposed [ ] Approved with conditions [ ] Denied [ ] 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 �� ( 4 (D �( / 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: I Reviewer to complete the following: Y / N Square footage of Use: Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / N Permitted as: Y/N Will there be food preparation? Under Section: If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE Circle the one that applies Parking formula: 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 Required spaces: Dept. FAX DATE Y/N Circle the one that applies Items to be verified in the field: Is parcel on septic or public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: Y / N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7,nninv to rmmnlPtP the fallnwinor. 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