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HomeMy WebLinkAboutCLE200800039 Legacy Document 2013-01-03Application for rvrn Al. s�' ZZoning Clearance 6-1" a` _,�\ OFFICE USE ONLY _ Zoning Clearance = $35 CLE # .� ®a PLEASE REVIEW ALL 3 SHEETS Check # Date: �'' C, Receipt # 6 L.j! f3 Staff: &EP PARCEL INFORMATION Tax Map and Parcel: 6 ( I U (9 ©3— 0 0 6,07 DO Existing Zoning r-7 LU /V ry Parcel Owner• 0 CAJ I d Parcel Address: 3012. 6VK AA2 On , U )J_ City C NA p (.o P% y IL F State VA Zip Z�Jo I (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? FR A N k L A 0 Address : City State Office Phone: (7o3) Zed ` 3 X33 Cell #$)1 6y1 7013 Fax # 703 ZSo `/G7 E -mail APPLICANT INFORMATION Business Name/Type: KfIfAS CONS Ot-10 ATE p 0ZI UEY( lz d U CA 1-1 ON Previous Business on this Zip 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 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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. 0 [ ] This site complies with the site plan as of this date. Notes H o t crcowr`•• ; ,,,�� • Building Official C 4 9�= —` Date ")_1 1 v (j Zoning Official Other Official Date 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 ENO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report ( CER) packet. ❑YES F1 (C 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 ❑ NO Is parcel on private well or public wate If private well, provide Hea t i1T —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 ❑ENO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # / ❑ YES / Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 60n1n21 TeCh to COMMete the Ionowme: Violations: l ❑ YES NV NO If so, List: Variance: ❑ YES /❑ NO If so, List: Reviewer to complete the following: Square footage of Use: [YES ❑ NOa�� Permitted as: Under Section: R4 °? ` / og) Supplementary reT lations section: G Parking formula' Required spaces: ❑ YES ❑ NO Items to be verified in the field: Inspector : Notes: ®' YES ❑ NO If so, SP's: ❑ YES dNO If so, List: Date: 511106 Page 3 of 3