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HomeMy WebLinkAboutCLE200800053 Legacy Document 2013-01-11Application for Zoning Clearance ��yoe nrv�,l. County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of 3 OFFICE USE ONLY CLE # �d ©r Zoning Clearance = $35 Check # ;t;7 Date: PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION j W ©' 0/ — QJ b 00& 0 p Existing Zoning Tax Map and Parcel: ��� J j r Parcel Owner: Parcel Address: c�i c i e f — Cit}��4i____ C/�i1G�G L�5'yJ �/ State Zip 2 9G (include suite or floor) PRIMARY CONTACT // `! cC rcd S Who should we call /write concerning this project? C'Clk ,5� 1 1 ^� L :J'� '3td �Zl'c ' Zips Address :b ( "I U ►-i1 S City G.itt, i� State .7, 7 - Office Phone)v2oid� Cell # -)'K e- r I � al), ' S 1 V- r� �n APPLICANT INFORMATION / T �L ©'�?'J ` �S Business Name /Type: �.� J l i M' S'13 a G c9 C G tt" D l S l 5 Previous Business on this site Describe the proposed business, including use, number of employees, number of shifts, available parkin spaces and any Q O F --k additional information that you can provide: t c 5 1 h P S 5 c ! VL P rC� *Thus 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 aqd accurate to the bist of my, knowledge. I have the conditions of approval, and I understand them, an d that Iwill abide by them. read Signature Printed 4,Z f!C / 3 �►'�SLG�e iZ ` APPROVAL I FORMATI N [ ] Approved as proposed [ V(Approved with conditions -7 - DMTM 39R- 9 f,Pri�lce and/or [Vf Elackflow prevention device and /or current test data needed for this site. Contact C [v] o physical site inspection has been done for this clearance. Therefore, it is not a et r�i2 ��itix9An�(t e fisting Contact site plan. ACSA 977 -4511, x 119 [ ] This site cgrr�p 41 the site p n as of this date. Notes: !1� (/ J / Building Official Date 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 5/1/06 Page 2 of 3 Intake to complete the following: F-1 YES F-1 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 ❑ NO Is parcel on private well o ubli ater? 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 =sewer? ❑ YES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES [5 NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning 'Tech to comDlete the tollowina: Violations: ❑ YES FL If so, List: Variance: ❑ YES If so, List: Reviewer to complete the following: Square .00tage of Use: ❑tI YES ❑ Permitted as: / 1 Under Section:.3, Supplementary regulation section: A Parking formu�a A Required spaces: # ❑ YES ❑YES NO Items to be verified in the field: Inspector : N Proffers: F-1 YES 0iNO If so, List: SP's: ❑ YES Fl,]-`N—O If so, List: Date: 511106 Page 3 of