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HomeMy WebLinkAboutCLE200800033 Legacy Document 2013-01-03R Application for Zoning Clearance Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY a 00 CLE # Check # Q . Date: A — ' Receipt # Staff: PARCEL INFORMATION It p S Tax Map and Parcel: -76 �7 Existing Zoning co Parcel Owner: aA 1 ~S# Aj 61P I/,YQAt ib. ig�44 *" Parcel Address: AR C Am A-4 t14— City CiV-- b1(eSvY1 S State ✓A Zip1;2q03 (include suite or floor) PRIMARY CONTACT �SGcal/l U ✓✓-�- >�C&.-�� Who should we call/write concerning this project? i/aQ� Address: Po &DX 4(66z a Citydow(o ksv+(lt- State JA Zip AJ de - Office Phone: 16FC ) ZS30� Cell # Fax # E -mail -SI'W 7✓ ay APPLICANT INFO ATION Business Name /Type: ✓G?d�iCszd¢ Previous Business on this site ___4 (C- Describe the proposed business, including use, number of a ployee , number of shifts, available parking spaces and any additional information that yo cap} provide: Se®.rctG `�S 1i 'S� ev Us�K rz 5F✓�r�-ftm_ 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 accurate be t f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed APY—RO VAL INFORMATION / De ce and/or [Approved as proposed [ �/] Approved with conditions Bet�te [✓] Backflow prevention device and /or current test data needed for this site. Contact ACS s Lata Needed [ ] No physical site inspection has been done for this clearance. Therefore, it is not a dete}7ct�filtb�alr �91n Sit Ian. [This site complies with the site,plaq of this date. f � Q Cc otes: Wi car�e4��?n -� (- b a7�dt �tya b �! w�. T Building Official c Date c�, F- Zoning Official Date 1 Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/l/06 Page 2 of 3 qzl$ Intake to complete the following: ❑ YES ❑ NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ 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 ❑ YES 2 N 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 ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit, Permit # []1YES ❑ NO Will there be any new construction or renovations? If so, obtain the proper Permit. /0 Permit # °'7 ,G) (� / DC)7 C— Zoning •Tech to complete the Violations: ❑ YES ©ENO If so, List: Variance: ❑ YES FVI NO If so, List: Reviewer to complete the following: Square footage of Use: " ✓ /��� YES �jO Permitted asY� 1"f Under Section: OV, 64j46!; (`J 1 Supplementary regul ons sec ,n:I , 1. 09-1 Parkingformula:s4t,- p /,,,, Required spaces: ❑ YES ❑ NO X717 ►�/ f % �� 1`� Items to be verified in the field: Inspector : Date: Notes: OYES ❑ NO If so, Li es Q� Y'o- S [ YES ❑ NO If so Lis 0 0 9) `d I 'M 0a ,y : -crp 5/1/06 Page 3 of 3