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HomeMy WebLinkAboutCLE200900083 Legacy Document 2012-08-31Application for Zoning Clearance CLE # o� X $ it- OFFICE UE QNLY tai iD f Zoning Clearance = $35 Check # Date: PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: / PARCEL INFO ".WA�ION /� N G Tax Map and ParcS � /°oTi1 W JC ©, y s e t � tr 'L -Z Existing Zoning ' C ° ' � ✓H� i'c i c2 G Parcel Owner: (A Q YA ie-5 WJ. j/ t, r'7- Parcel Address: 1? 9 5 h T A)'t,4 R.: s "' City �3 C &i -Ic77 esly State V Zip �-�`� fl (include suite or floor) PRIMARY CONTACT Ss Who should we call /write concerning this project? )P'G i c L c,, , ` y �r` SU,cState V/j Address : )CIS -S�o� IVa.I° Rd_ StLI70 L Zip:zaW/ 11. .3y-� -7 Office Phone: ( 1) 2`� ' 3067 Cell # ��� T S-, c, 6 Fax # D-g-3 ! 93--)E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name %C New business Business Name /Type: C C' h T Ae L- V /4 S E' y V> C es -- '� -per Previous Business on this site 6 o6 / ec 4 a cgR ! `e- S Describe the proposed business including use, number of employees, n mber of shifts, available parkin s, nu f vehicles, and any additional information that you can provide: , 4— lor *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 bes of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed 11X ce L 57C, ec / X4 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 �— DateT�`i Zoning Official Date c�4/ T' 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 u m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y 1'tl'i Wil 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 �epartmen?t If private well, provide Healrm. Zoning revi ew can not begin until we receive approval from Health Dept. FAX DATE Circle the one that app] e Is parcel on septic o public sewer? Y AD Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /Ia Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7nnina to rmmnlata tha fnllnwina- Reviewer to complete the following: (> Square footage of Use: -75 /N ermitted as: /p +^�-� 1(44;lve{S S94)lI Le' Under Section: 2 7 2 Supplementary regulations section: Parking formula: / X Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violati ns: Y/6 If so, List: Proffers: Y/� If so, List: Variance: Y/ If sowi , st: SP's: if/( If so, ist: Clearances: fps-- 2-S SDP's Revised 04/28/08 Page 3 of 3