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HomeMy WebLinkAboutCLE200900196 Legacy Document 2012-10-15Application for Zoninjj Clearance CLE# 4D�— 1 � SIR INIP OFFICE USE ONLY N] Zoning Clearance = $35 Check # gr q _3-�Q Date: PLEASE REVIEW ALL 3 SHEETS Receipt # —76 /_ Staff: VTS PARCEL INFORMATION (DC0 Tax Map and Parcel: ©96 6 a — f — UG — 6A 1� _Existing Zoning Parcel Owner: ,.S"Hart in/G n Parcel Address: 5 ?P-fr "rAAX-- a ( A& Cil- City CO, State VA Z1p22432 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? OZZ 9 L-O T 4 {- Address : 5 ' city Gt -+ L(-,e State \/P1 Zip z-U1 l �./�G�� 3 W - `i (,4 - n Office Phone: dill 1 z1I L - 5'V Cell # Ot C'U � Fax # E -mail J` UJ' A LTL 2S APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: 6 `� �� c � �t (` t- i'1�: c .A , � fv�y L u, Previous Business on this site 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: `tA +� PLA, UA r► �� G t= Cl� -Lr',n NV ''1- - -S *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 thebe t of my knowledge. Ihave read the conditions of approval, and I understand them, and that I will abide by them. Signature . q l/ e-�C ✓rt ~ Printed /mac G K7 --7' . GVA 4,-Yc y1; APPROVAL INFORMATION Approved proposed [ ] Approved with conditions [ ] Denied pp as p ro p "[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, X.H-9: I 1 [ ] 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: �— Date Building Official l ry 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 Intake to complete the following: Is/ Is us in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y it 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 wep ic er? If private well, provide Heal ubleD "partment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic o public sewe . D/ N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y %)z17 Will t ere 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: V/ N ) Permitted as: -5'r444,,AA eva Under Section: Supplementary regulations section: Parking formula: Required spaces: Y /A Items to be verified in the field: Inspector : Date: Notes: Violations: YI&Est: If so, Proff : Y /I If so, List: Vari . e: Y/V If so, List: ,SP's: Y f so, List: Clearances: 1µ0 SDP's /3 ns�n -�iz Revised 04/28/08 Page 3 of 3