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HomeMy WebLinkAboutCLE200800018 Legacy Document 2013-01-03Application for Zoning Clearance 6 ❑ Zonina Clearance = $35 OFFICE�TSE ONLY CLE 4 065006 PLEASE REVT'EW ALL 3 SHEETS Check Date*, _05 —1 —A Receipt # 54, Staff- F �1 � C'E f NS T R­ 1A T 10 N Tax Map and Parcel: 31 Existing Zonino Parcel J'arrel Address- (0,70 Pd� A"". City State \/V zip (include suite or floor) PRIMARY CONTA.CT Who should we call/write concerning this project? Address State U-4 --Zip Office ],hone, Cell # __Fax ail j APPLICANT EYFORM"ATION Business Narne/Type: 41. b-e 1 1 -1 > r lad 114 e 21!1 tz Previous Business on this site 4/o fV,:F'* Describe the proposed business, including, use, nitniber of employees, number of shifts, Available parking spaces and any additional information tDat "it can provide: *Tbis. Clearance will only be valid on the parcel for which it is apprtived. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. j hereby cerfii'-i that lown orhav,-the owner's perrnissivn to use the ,,pace indicated on this applicatio . I also certify that the information provided is true. and accurate to the best of my powledge..'l have read the conditions of approval, and I understand tl:em, and that I will abide by (bern. R Signature Printed NP F 1 7AL INFORMI-Xf ION [ P Approved as proposed Approved with conditions j Denied [/I Backflovv prevention device and/or current test data needed for this site. Contact ACSA, 9771-4511, x119. -1� for this clearance. Therefore, it is not a determination of cotripliance -xith the existing 'o p! sic.aj site inspection has been done �- xplan. This s site s I with the site plan as of this dote:. Notes: Building Official _d -_'l e Date Zoning official Date. Other official Date County- of Albemarle Department of Comminjqr Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 511106 Page Z of 3 I Do/ 10 0[n SGOznc`se-a PU*TaQqWn0 ZGTT SVZ PEt XV9 3Z -£T CIM'd 800Z/EZ/10 Intake to complete the following: ❑ YES ❑ NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified En_ineer's Report (CER) packet. ❑ YES NO Will there bet od preparation'? If so. give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑ YES ❑ NO Is parcel on private well o u is water. If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑ YES ❑ NO Is parcel on septic ublic sewer. ❑ YES g NO Will you be putting up a new sign of any kind? If so, obtain proper Sian permit. Permit # f YES ❑ NO Will there be any new construction or renovations? If so. obtain the proper Permit. Permit # 3xp � - o a 6 (0 "t )' 6 Gonmg I ech to complete the tomwnlg: Violations: ❑ YES YNO If so. List: Variance: ❑ YES ©/O If so. List: Reviewer to complete the following: Square footage of Use: oL I © YES ❑ NO ` Permitted as: G� Under Section: 26A . Q • I ----y Supplementary regulations Ulu Parking form'il42 Required spaces: 1 6 F-1 YES Q 14 O Items to be verified in the field: Inspector : Notes: Date: 5/1/06 Page 3 of 3