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HomeMy WebLinkAboutCLE200900094 Legacy Document 2012-08-31Application for9 Zonin Clearance q CLE # 4 �, �' C! �hicaN�P �- e "� }.: " t 4 :�1. a �,��+E�'nv it J„q� - .. -<r� ✓,��Yr�. � r.i�'''k: t '. � ,1F°,' � y '� Y s'�s�k.. J�„Z+Stl c"�,sYee �uki4' �' �O Y i ..� -: .r:.4`i2+073 H'%3 +gnu N,Ah.... 4{SP11{e+bz}•�t e`� /�' #'3 ea;�.'i? o •Sd(_'6 npy,Ht­ ,&�:,%�• r a Bi�Y� �'3G�{"'s k.e it.�! `i z'.2d'."r!t K 3 r t 3.&�tt4�f5 k:, 1 "`" •.',• i, + i. .. �wx. rvltrz,•. WF. A. .�' #A?�FtA'FNf�ftt.��„1 »'H4ewm{ ire.. tw,. 4.>: -.ah.Y e�ns,r_.r..e Y f .fir PARCEL INFORMATION Joe, T1Y1 P `� 055E-01 -136 6000#4016, 0 Existing Zoning AJ07 D "/�%�a G tor Tax Map and Parcel: 5 JA0LJ P/•o(JG+(• -cs� LLB Owner: /►'`141ZCk .4.'n //� 1/ Nea+7 A-l�C 'Co C %2� 1" Parcel Address: /DOS IV0_&46lGI,, State y zip2293 (include suite or floor) OL-D W gArc, Vf C t_A G&- OO -Ar", PRIMARY CONTACT Who should a call/write concerning this project? �w' V. D 60X 2(a State 04 zip, ?Z 93 Address : - 7 city 20WV4 Office Phone: 8Z3'�9o2 Cell # 7'ZyZ�5ff ax # E -mail Qah 1. Zszq - VI !`•e • 6oph APPLICANT INFORMATION °V 1-�t/C e Ke, kid Business Name/Type: e57 lY II /, $ . 1 TU/ 1`L� Previous Business on this site IVOlt — AMWA/ C ilSf2yG1itsrt Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and an additional information that you can provide: G fA t L t * 4 5 � ✓G L0#44, G�►u is eG5 one Sl„' � 1,?Al poorkivil accs an e s ,m *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 infonnation provided is true and accurate to the owle dge.' have read conditions of approval, and I understand them, and that I will abide by them. Wofm tthe Signature Printed boMA b I�. 1�1t -L "1�I� -e &VWI�- APPRQVAL;INFORMATION [_ ] Approved as ;proposed s F [ proved with eondttions [ ]Denied .� J 136ckflow prevention device and/or current test data needed forthis site w Contact ACSA, 977 4511, x1:19 [ ] No phystcal_s`rte mspectton has been done forhts clearance Therefore, tt is nol a determmat }on of com�hance with the existing site plan; Thts sttewcomplies w th'the site plan as oftlus date N] Dies. ': � x54F:zly� Ft °­/ r Building Official Date alp r Zoning,,Offieial Date 7 a Other Offictal ; V . a; " n.Date s 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 take to complete the following: Y 16) Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/© 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 ublic water9 If private well, provide 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 septic o pu is sewer. O/ N Will you be putting up a new sign of any kind? Sign permit. Permit # Reviewer to complete the following: Square footage of Use: (t)/N Permitted as: lr—A-0-�A Under Section: wk6 C.odw — Supplementary regul4tipns section: V� Parking formula: Required spaces: YIN Items to be verified in the field: If so, obtain proper Inspector : Date: Y/® Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonin to com lete the following: Notes: Viol ions: Y / CN / If so, ist: fers: FN List: -r - Vari�me: Y M� N If SYLit: N Eos , ist: Clearances: SDP's Revised 04/28/08 Page 3 of 3