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HomeMy WebLinkAboutCLE200900184 Legacy Document 2012-10-15Application for Zoni Clearance CLE # 25 Zoning Clearance = $35 OFFICE USE ONLY nn Check # 5 Date: t 'G PLEASE REVIEW ALL 3 SHEETS Receipt # ' Z Statf: i PARCEL INFORMATION y � ) q ( l� / '- "1 `7 Tax Map and Parcel: Existing Zoning Parcel Owner: {2.l• 'Qe. ,ef- Cvs�ow. Kowv�� Parcel Address: EsO Ktkwr e_rs P[(Xce_.S --('3a City State VAS Zip X911 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? 24a,� 7y+ IN Address: 1o40 t4uyLter-s ?kce , S7E t©a. City 1 10r-4 *t4eSyi)(.e_ State y/F1 Zip Office Phone: ft3`4 trio_ 787$ Cell# 5j ? °317, 21f'(3Fax# E -mail -f ft jAmmadu All Pill, APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name jC New business Business Name /Type: ale c4L rc. Previous Business on this site tJ 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: G�J j o r 28sL�_a r?w em p 1 ®w *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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed �v a„� �ul n APP VAL 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 complies with the site plan as of this date. Notes: Building Official Date ((( (d 0't Zoning Official Date 1 /Og 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: P� LI, HI or PDIP zoning? Engineer's Report (CER) packet. Y /N) If so, give applicant a Certified Will there 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? iJ (ft 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? N Y /(9 Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /& Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: ' 'Y I1 N rmitted as: Under Section: Supplementary regulations e-lion; �l Parking formula: J 2�Q Q Required spaces: Y/N (� Items to be verified in the field: .�J /� 21 Inspector : Date: Notes: Violat' ns: Y/ Ifs ist: Proffe Y/� If so, ist: Variance: Y KlizTl If List: SP's• Y/ Ift: Clearanc SDP's JRevised 04/28/08 Page 3 of 3