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HomeMy WebLinkAboutCLE200800023 Legacy Document 2013-01-03Application for Zoning Clearance 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 OFFICE US�,ONI U el-Zoning Clearance = $35 CLE # Check # �S2S Date: — /- PLEASE REVIEW ALL 3 SHEETS Receipt # Stalf: PARCEL INFORMATION Tax Map and Parcel: 6,7ro —0,D — oo -077Z?o Existing Zoning Parcel Owner: Parcel Address kidmw C� C CiX a f l 0 � LA-ate VA Zi L' (include suite or floor) PRIMARY CONTACT Who should we cal/write concerning this project? , 1 �UL�JV�J Address :c A CU a an City WesWuate VA Zip?/,rl I 1 Office Phone: �4 IIC'ell# Fax# ll•45 /�E-mail A- APPLICANT INFORMATION. Business Name /Type: ��L�j / ktJA tE/l /l &NV (,3�&i0f l --ef7 1`J 1 T_T c Previous Business on this site-?) I V Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any additional information that you can provide: *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required I hereby certify that I own o1 h e the owner's permission to use the space in i6ated on this application. I also certify that the information provided �f is true and accurate to the be t f my knowledge. I have read the conditions approval, and I understand them, and that I will abide by them. Signature Printed S-,J APPROVAL INFORMATION [v]AApproved as proposed [ ] Approved with conditions B�aekflom[Dp*R&'ud/or [ j/]/Backflow prevention device and /or current test data needed for this site. Contact C JJ&ffi 7P,9$;1ata Ne�e�led [ v]INo physical site inspection has been done for this clearance. Therefore, it is not a eel} atto�q��yjgt�if�p "f�aiiCdviPl'aliele fisting site plan. --- �-°� °° [ ] This site complies with the site plan as of this date. Notes: Building Official Date `Z - 69 2K, 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 511106 Page 2 of 3 Intake to complete the following: ❑ YES 0 NO Is use in LI, III or PDIP zoning? If so, give applicant a Certified Engineer's Report(CER) packet. F-1 YES ❑�rt(/O 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 ❑ YES 2"NO Is parcel on private well or public 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 or public sewer? ❑ YES �Nv Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Coning '1'ech to complete the following: Violations: ❑ YES ✓❑ NO If so, List: Variance: ❑ YES © NO If so, List: r Reviewer to complete the following: Square footage of Use: l t ( O DYES ❑ NO Permitted as: Under Section:l Supple tary regulations section: V1 Parking formula /'�00 • _ �-a Required spaces: ❑ YES ❑ NO Items to be verified in the field: Inspector : Date: Notes: Proffers: ❑ YES Ld NO If so, List: SP's: ❑ YES ©"NO If so, List: 5/1/06 Page 3 of 3