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HomeMy WebLinkAboutCLE200900136 Legacy Document 2012-10-01Application for Zoni Clearance O CLE # , Zoning Clearance = $35 OFFICE USE O Y I I ' Check # Date: r "I I PLEA& REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION r Tax Map and Parcel: (� / / -� Existing Zoning 1 Parcel Owner: 5 t fo PP-Ch) 6 C FN 7' R ✓ 1-SS- 0 C-EA 7 t .S 0 5):-'m -ru �G iTiP�" ` /C/ Parcel Address: / � ° ''1 r� City L��/'"� Cv 7.76 AC V/� i Zip 22�i° (include suite or floor) PRIMARY CONTACT L �� S�P � lc L11-SH Who should we call /write concerning this project? Address: I?(/ I Cn CAJ GT_qP1'la l City SA-5 State V14 - Zip,,,?0 /-007 Office Phone: ( {i j ` 05- -5 o f Cell # _-7-63- 4Zi _ -5V i1Fax # E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: �, 1✓ /7L /l� J�/q _-S46_ / P(.111 %J G TILT 7C' Previous Business on this site /I A /<j,—/v tz 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: -1­5_ Al P 09VI- 1,4WAtCAl � 57TRA4 6 �Gocve S PoG�s o �ilLES _ 5? A -7 E' : 1 -;;z 6'G o Y6 61;r S1 ) JO-4- , t.,O T s or- ©/1 /�' K.rr+/ a *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 YO S cp f'-14 ffS LAS % OVA r 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 o with t site plan, �CUA "e AV X Notes: 6t W qS jI a4 ek r Building Official �— Date -4. Zoning Official Date of 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 3LL-0 :)M S t Intake to complete the following: Y/ Is u 6I, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /l�N J Will ere be food preparation? If so, give applicant 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 blic wat r? If private well, provide Health epa ent form. Zoning review can not begin unti we receive approval from Health Dept. FAX DATE Circle the one that ap Is parcel on septic o public ewer? 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 ew construction or renovations? If so, obtain the pr er Permit. Permit # Zoning to comDlete the following: Reviewer to complete the following: Square footage of Use: )y A V1 N 'Permitted as: ZloocnaJ Under Section: I/%4 I Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: 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