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HomeMy WebLinkAboutCLE200800017 Legacy Document 2013-01-031� r LL Application for Zoning Clearance /eft.! OFFICE USE ONLY � ❑ Zoning Clearance = $35 CLE # a5cl o o o v 7 PLEASE REVIEW ALL 3 SHEETS Check # 3i�LQ Date: I —,;14 Receipt # $q O ( Staff. yr� ? PARCEL INFORMATION Tax Map and Parcel: y 415 GU —b 3--oA — 56 U D C Existing Zoning Parcel Owner: ? cd E0YLD(ZffD . WC, ( Parcel Address: OD -e -)w A ttPO ity L.1 ICaf �L-AL A_state Zip �)XOI (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? C eO c -Tncl�_z)LY-) Address: V�y �[�'Y��� ��Q� City �t State v� Zip ?Ul Offlce Phone: ivy)) 8Z).AbCell # t�bqD51z a x #5yD' $a`�� mail APPLICANT INFORMATION Business Name/Type: 5k{_)Ch\4. Previous Business on this site ­Tbw -,= C'Q_, Describe the proposed business, including use, number of employees, number of shifts, available parking s aces and any additional information that you can provide: ��� \�Y� 7 `�t�6' -VO QY'('%Qii aC(A �x 1 c c� . -� \�..'� f" 1 c�•w -.�\rti . a �c� !l S -".h.� vg;b smnctio - 'L 'so i- *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 accut•ate to the best PlInyviowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature t Printed A C o� APPROVAL INFO ON Approved as proposed [ ] Approved with conditions [ Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact CSA, 977 -451 ,x119. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a�eterisaiaaatiou- of_com liance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Zoning Official Other Official Date F I (T I / Date / �'� / 07 Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 511106 Page 2 of 3 Intake to complete the following: ❑ YES ©' NO Is use in 1,I1"HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. V' YES ❑ NO 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 4 ❑ YES ❑ NO Is parcel on private well or public water? If private well, provide 4alth- Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑ YES ❑ NO '^ Is parcel on septic oa public sewer? ❑ YES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ?'AYES ❑ NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning Tech to complete the following: Reviewer to complete the following: Square footage of Use: 114-7 YES ❑ NO / ( i Permitted as: 2 • I Under Section: ZZ.Z Supplementary regulations section: Parking formula: 4y.7S Required spaces: % ❑ YES NO t� Items to• veri e fied in the field: Inspector : Date: Notes: Violations: ❑ YES ,ZrNO If so, List: Proffers: ❑ YES-.Z—NO If so, List: Variance: .[/]✓YES ❑ NO If so, List: SP's: ❑ YES NO If so, List. 5/1/06 Page 3 of 3