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HomeMy WebLinkAboutCLE200900112 Legacy Document 2012-09-10l Application for Zoning Clearance_ ®�`� CLE #� DQ, �- `IR[•,tN�P OFFICE U Y X1 Zoning Clearance = $35 Check # Date: f PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: 07800-00- 90- a 55 A8 Existing Zoning P K Parcel Owner: le Marke� Place o-f V4 nta . L. C• 0 ,y�yy�� p I / Parcel Address: ) +66 po it t l ff1gy,11411\ Ploce city a � State VW Zip 2411 - (includes ite or floor-) PRIMARY CONTACT Who should we call /write concerning this project? LIB y� Address: M 10 pa)A, City yyU;iOUTTt 6-01t, State VA Zip 2-7.1 Office Phone: t( 12, ��� �� �� Cell # Fax # E -mail d&3y C V `2oo1 4� Ct 0) • L l)m APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: 3000 U.Wne D %, P6 C�'( y*a\ offic , Previous Business on this site Y1bY1P� 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: : c *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 flee best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed 30,CQ LU L i Q e C"e_ 11-1 V AP OVAL 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 s'te complies with tl site plan as of this date. Notes: Building Official �., , C. Date Zoning Official Date '% I ©q 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: Is/ Is us m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wil re 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 pu lic ater? If private well, provide Health ment form. Zoning review cannot begin unti .we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or u i wer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # - -- - - - - Y/N Will there be any new construction or renovations? If so, obtai the proper P rn�iX Permit # Zoning to comDlete the following: Reviewer to complete the following: y n Square footage of Use: ? v� q �itted as: � C-e- Under Section: J q • 3. Z Supplementary regulatio s section: & 116L Parking formula: /1 -P5 Required spaces 6 Y/N Items to be verified in the field: Inspector:-- ----- Date: Notes: f Violations: Y If Pst: offers: /N so, List: Variance: Y / If sOf, st: 's / -so, List: VV Clearances: SDP's Revised 04/28/08 Page 3 of 3