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HomeMy WebLinkAboutCLE200900202 Legacy Document 2012-10-15Application for ZoninF Clearance CLE # Y—U ©7 ° OFFICE USE ONLY Vzoning Clearance = $35 Check # eA-1 Date: /! id- O f - - - -PLEASE REVIEW ALL 3 SHEETS - -= - - - - Recei t # 7 ? - -- Staff: PARCEL INFORMATION Tax Map and Parcel: Existing Zoning Parcel Owner: C � L(z(. j Parcel-Address: � �� I_ �; �t�91 _City C# `Vi / `(JI_ State =L IZA - - Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? �-A)190) Address: . -� �� l���j City j State 1A Zi 2i'2�0 Office Phone: " M Cell # c ax # E- mail" 10-4116�, &d k � anc APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type:TA S/6 yL+. -• Q YY Previous Business on this site - 1 � • a-- ad bbu aiAtin Describe the proposed business including use, number of employees, number of shifts, available arking spaces, number of vehicles, and any additiopal information that you can provide: _EEO nau icy �— `Fi k .[ // (I"JIV zpm N r -11-1 *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 lave t le vWpeni to use the space indicated on this application. I also certify that the information provided is tnie and accur to the best of m cread the conditions of approval, and I understand them, and th(at�I will abide by them. Signature Printed ( L APPROVAL INFORMATION [ ] Approved as proposed [ L44pproved with conditions [ ] Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117. [ ] 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. // II ff Notes: No CA i'I�S o GAS a.�/(.UY1� I �1�'�t -g ,i CV S-1- 6rY'pO- 'PGLY Building Official Date ( :4-1 (% l/ Zoning Official ✓ v LT1 Date Other Official % /U 9 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, 10/13/09 Page 2 of 3 Q�') r , to complete the following:--- _ - Y /& Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. V i ill_there be food preparation? _ if so, give applicant a Health Department form. Zoning review can n t b in of we r. ceive approval from Health Dept. FAX DATE �1 Circle the one that applies / Is parcel on private well or p lic w ter? If private well, provide Health e t rent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that app ' s Is parcel on septic or ublic se er? J/N Will you be putting up a new sign of any kind? If so, obtain proper Sign- permit._ Permit # �/N ill there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7nnin¢ to comnlete the followinu: eviewer -to complete the owing: Square footage of Use: G Permitted as: Under-Section:- dam( Supplementary regulatio s section: 1411L DL Parking formula: -h/M1-, Required spaces: Y/N Items to be verifed in the field: U'a'e- Notes: Viol ons: Y /� If so, ist: Proffers: Y /� Ifs ist: Variance: Y /(I If so, st: SP's: Y/N If so, List: Clearances: SDP's Revised 04/28/08, 10/13/09 Page 3 of 3