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HomeMy WebLinkAboutCLE200900154 Legacy Document 2012-10-01awn Application for Zoning Clearance �` °� /; CLE # 7 /<V U W 7 OFFICE USE ONIY qr2 i ].Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS Check # Date: (5`�q Receipt # Staff: PARCEL INFORMATION Parma 1 $ Tax Map and Parcel: 61 - Se GfilDn f gra�l< Existing Zoning C- Parcel Owner• ✓ee��✓1 L' P �v` Lt-C- Parcel Address: 3170 4,eev)b1I c4'.) r �jq.2 City (- '0ay101tK,1J1e State VA Zip 2Z &70t (include suite or floor) PRIMARY CONTACT lglp p S7tetvav-r Who should we call /write concerning this project? Address : 8q3 )Ow5f -City 6W1r1Olfe5'VJ1,C State Vl Zip 2.7,10Z QQAo� r� !/ Office Phone: !� Z �v�� Cell # 3i 27 3 U Fax # E -mail rP-I PPVM b e Yeihoo, Lodes APPLICANT INFORMATION Check any that apply: __X Change of ownership Change of use X Change of name New business ,�gg Business Name /Type: �eenb ger i5meipgencV Ally gyp► &d — Ve--tevt Y?,0,,7 ®i6 CC" r 5;ervia4 ` Previous Business on this site ye-( ��� eMey-qenc� I�P�tme�if e - t��'I �e.. 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: - 6V 0 f & OA eMPW MCI? l/Q 1 Af r4VV 0 141pl N101 /- -uo to o <A( - A ",,j ejork- O -- Pam <h o9-' wtee� -A h& ✓ Of {ors do w s R si r,e" g-e olerr z uo kwPew *This Clearance will only be valid o e arc ,e} for which it is agprov d. If yo ch nge, intensio or move the use to a new location a new Zoning Clearance be ��A'� ' pcl � � �P Pa m.5 `%eve4r Ry ASS Pw- 4a /Q will required. 0-f- atol" hu5kA6 its 1 ©C4 .n Aepe- erje i1v 36/-, ) �J r did ,,A"tc. 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 t • ie best of owled e. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature ature � l Printed X21 /Rp Si'tCGi a �° r APPROVAL INFORMATION [° ] Approved as proposed Approved with conditions [ ] Denied [ ] B cicflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119. C o v physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ]This site go se with the sit plan as of 's date Notes: Building Official Date Zoning Official Date �� 641 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 M ti� 5-- Yens Intake to complete the following:, Is / Is us LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /1`t�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 or public water? 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 or public sewer? 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, obtain the proper Permit. Permit # Zonin2 to complete the following: Reviewer to complete the follo Jwiing: Square footage of Use: �� �v mitted as: Under Section: Supplementary regulations sect' Parking formula: AL51-2 Required spaces: 1 Y/N Items to bp verified in the field: Inspector : Date: Notes: Violations: Y/ If s ist: Proffers: Y/( If so, ist: I Vari ce: If / N Ifs ist: SP's: �7j 'ICY so List: Clearances: SDP's Revised 04/28/08 Page 3 of 3