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HomeMy WebLinkAboutCLE200900172 Legacy Document 2012-10-11Application for Zoning Clearance CLE # �20 D q ° V12 ing Clearance = $35' JQ OFFICE USE ONLY Check # '1 �d 0 Date: /()1 Q • 9 PLE VIEW ALL 3 SHEETS _' Receipt #:,_ 1 Staff.• PARCEL INFORMATION Tax Map and Parcel: 07 1306.00 -00 '• Oq%4e2. Existing Zoning 14 L Parcel Owner: VtR(�tNIA LAND 4tZ 1)Si n `' Parcel Address: 101-5 1 �/ub , h City V • V �� State \)A- Zi,�ag t (include suite or floor) u �T PRIMARY CONTACT Who should we call/write concerning this project? S Xp yr_ ow u r l & V Address: rj -E xyeAkk,vJ D1 • City 016111 [ e— State VA Zip Office Phone: C154 a �• Cell # O�D't�SS9 Fax # g�(9 'J5 �0 E -mail b�l L s COK-1 APPLICANT INFORMATION Check any that apply: '; Change 0f ownership Change of use., Change of name New business ;. Business Name/Type: l�,r 6 s Sal l�c�► `,u� t�.cew� rya Previous Business on this site L UA , 119L Describe the proposed business including use, number of employees, number of shifts, available parking spaces, n er of vehicles, and any additional information th ou can provide: Wj Q L4 el,"Olr*ees • Y1 i 30,E — oa *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 est of y owledge. I have read a co itions of approval, and I understand them, and that I will abide by them. Signature a' Printed 5�= �/`¢�=� LZ j v�ti 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 pl This site complies with the site plan as of this `date. Notes._ _) n )_9 Building Official Date Zoning Official Date 0 :. .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 pMAJ 1�5. �0-� 1,ULl Ai-ylS 1�S���ca (36A(� D2. ��tTE-.,Z Intake to complete the following: Reviewer to complete the following: Y / © I Square footage of Use: Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Utted (n as: OXYI G& Under Section: M Yll Will ere be food preparation? AI If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary reg#tions section: Dept. FAX DATE W Circle the one that applies Is parcel on private well 9e:p water? If private well, provide Hea artment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that Zpfu lis Is parcel on septic blic s ewer? Y Wi ou be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YJN ill there be any new construction or renovations? If so, obtain the proper Permit. Permit # :a (')(j q =L4-3 r3 (o A Zoning to complete the following: Parking formula: Required spaces: t-y Y/N / Items to be verified in the field: Inspector: Notes: Date: Violations: Y /A Ifs , ist: Proffers: Y /O If so, List: Van' ce: Y / V If so, ist: SP' Y If so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3