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HomeMy WebLinkAboutCLE200900122 Legacy Document 2012-09-10a Application for Z nin Clearance CLE # 20 19- � /Rf;IN1P [Zoning Clearance = $35 OFFICE USE O Y Qj �� y� Check # L, (.P Date: t/ 'U PLEASE REVIEW ALL 3 SHEETS Receipt# 1U,015/ Staff: PARCEL INFORMATION Tax Map and Parcel: 00 " db ° O(" i 0,-A n Q Existing Zoning 0_omm_v v C_i cam- sb(ot Parcel Owner: 1S i o P ©c a1 �S b D t�S L L (L / Parcel Address:16KO ����� F_qA SuAd e �� City ,rr ire 1 ,S � I� State V" i 0— _ Zip a 0 (include suite or floor) - PRIMARY CONTACT. /write Who should we call concerning this project? Address: (4,930 A/'big y1 ted Cityral& 6611 itrc!r) State Vi ( Zip Office Phone: (]v '3) qQ -1f,,q 1 Cell # Fax # &o, E -mail mods APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business I Business Name /Type: �'�GC fe S S .IJ i S CocTC� f S Previous Business on this site IVY 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: ' at'oc i c e <, 4r -c, c.Me� *This (Meara&e 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 ac at t of my wledge. I have read the conditions of approval, and I understand them, and that I will abide by them. /be Signature Printed_ b m_ AP d AL 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 pl [ his si e complies with the site as of this date. plan P Notes:' 5U T 270 vvvt- Building Official Date 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 .Com i' Intake to complete the following: Is /t_Ny Is us m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/ Will t e 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 c a er? If private well, provide Healt Dep ment form. Zoning review can not begin un ' we receive approval from Health Dept. FAX DATE Circle the one that apF4er? Is parcel on septic or Y/N Will yo e putting up a new sign of any kind? If so, obtain proper Sign p rmit Y N ill there be any new construction or renovations? If so, obtain the proper Permit. e)�r rt #- A 09—G1 q & Zoning to complete the following: Reviewer to complete the following: Square footage of Use: � I q6 (5a"5-p<;', T> /N ermitted as: M+44� Z.. ( -7 Under Section: 2 2. �' Supplementary regulations section: h./ a► Parking o mula: �" I Parking f �C 6- �SCilG5 �C' 12��a, Y/N Items to be verified in three J ield: , 0 Inspector Notes: Violations: Y /(t If so / st: Proffe Y /I If so, List: VOce: Y If st: SP's: Y/ If so, ist: Clearances: SDP's Revised 04/28/08 Page 3 of 3