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HomeMy WebLinkAboutCLE200800041 Legacy Document 2013-01-03nt.!)� Application for Zoning Clearance'` "V" OFFICE USE ONLY oning Clearance = $35 CLE # -7-609-41 PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: Al Md- oo •-66- C)d -ys-i0 _ Existing Zoning G ORiIi �C �C� Parcel Owner: -P re rrNi P R L L_C_ C-) fib 1_ l-✓ � r L L, Parcel Address: 4 `7-() P('p i'Yl i P_ R' CL. q .ity C, F, v1 11,P State 1/0— Zip ZZ?bl sul,ver I 0 I (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address :L46d cityCh�`ttYO ��e�� �iG�' State V /i- Zip 5-19, -a a Office Phone: 63 rZ Cell # Fax # E -mail APPLICANT INFORMATION / c Business Name/Type: o A I- sh o e S/ Previous Business on this site C;I �� �l r CIS Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any additional information that you can provide: �° i NQ a'2 pzJ J y)di *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 ;:u best of my my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature c/- / - Printed Al A I -1 ` t` ` 74 , l- T AP ROYAL INFORMATION [pproved as proposed [ ] Approved with conditions LA'Backflow prevention device and /or current test data needed for this site. Contact ACSA, [ d_NA 6physical site inspection has been done for this clearance. Therefore, it is not a deterrr site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date 0 Zoning Official Date 6 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 9 ti Intake to complete the following: ❑ YES F�NU Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (C R) packet. F-1 YES 0 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 ❑ 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 ©ENO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES �- 0 Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning Tech to complete the tollowm Reviewer to complete the following: Square footage of Use: ! 0 [/YES ❑ NQ Permitted as: -,— Kx i k;oo Under Section: �' a•(�L / Supplementary regul tIx section: Parking formula{ y� / C) yt 4-a i 6C VT 9l Required spaces: � 0 ❑ YES ❑ NO Items to be verified in the field: Inspector Notes: Date: Violations: ❑ YES If so, List: I t/❑ NO Proffers: ❑ YES If so, List: NO Variance: ❑ YES If so, List: ❑(NO SP's: ❑ YES If so, List: dNO 5/1/06 Page 3 of 3