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HomeMy WebLinkAboutCLE200900080 Legacy Document 2012-08-30Application for Zoning Clearance °FA CLE # (F 0 Zoning Clearance = $35 OFFICE USE ONLY Check # C-45A Date: PLEASE REVIEW ALL 3 SHEETS Receipt # 75:Z- f j 1T Staff: ' 9 '-" - PARCEL INFORMATIONpp��/� Tax Map and Parcel: C/(f�� -%%© /%!1 r� Zo Existing Zoning Parcel Owner: �e i/1`G��G�,�►' -� LLY►� �c,�i ph Parcel Address: Z © V V Ci.I. G�Q i-� �n I (�fy J State Zip X10 (include suite or floor) PRIMARY CONTACT �,4.1 Q Who should we call /write concerning this project? L� ��tt��,, Address: r7-0 (, A-�.�6dL.t �tkc-OL- 4city State vim" Zip 29-7o Office Phone: ?4�—L 1 tkell # '—"' Fax # �— E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business P Business Name /Type: ���� co �S yr `2 "� � d� a,_,, JA h-e Previous Business on this site 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 accurate to est of my knowledge. I have read the conditions of approval, and�I understand them, and tth-;at�I will abide by them. Signature Printed --' t' (� 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 _:!i� `�-Z ('3�i 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 M N Intake to complete the following: Is / Is us on LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will ere 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 o public ater? If private well, provide Hea epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appl' Is parcel on septic or ublic s er? Y / Wil u be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /( Will there be any new constructio , - Dr renovations? If so, obtain the proper Permit. Permit # 44 d0c, 0A Zoning to complete the following: Reviewer to complete the following: Square footage of Use: wj A Y/N Permitted as: m V -t 1 Under Section: - 100owtJ W4& .Kl Supplementary regulat'ioo s s ction: Parking formula: Required spaces: +V 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