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HomeMy WebLinkAboutCLE200800059 Legacy Document 2013-01-11c Application for OFFICE USE ONL CLE # a b © e 6(:'55' q Check # Date: '3-2c> -39 Receipt # 47W6 Staff: U-s PLEASE REVIEW ALL 3 SHEETS Zoning Clearance Tax Map and Parcel: 07800 O 00 —0c) -- ZP6 Existing Zoning Parcel Owner: T /(3 ' v�' CeAlkr ❑ Zoning Clearance = $35 OFFICE USE ONL CLE # a b © e 6(:'55' q Check # Date: '3-2c> -39 Receipt # 47W6 Staff: U-s PLEASE REVIEW ALL 3 SHEETS PARCEL INFORMATION Tax Map and Parcel: 07800 O 00 —0c) -- ZP6 Existing Zoning Parcel Owner: T /(3 ' v�' CeAlkr Parcel Address: V 9?/" 0 / i� City 1 �1� ' // State Zip (includ6fsuite W floo PRIMARY CONTACT nk% k +O Who should we call /write concerning this pro ect? 'Canto ���� °^ Address: ,,�(� A) RD City hm, State j,4 Zi -11 ,0� Office Phone: 7 /, — Cell # Fax # / ? �E -mail P-9Ac /lk h—Z, LL1 APPLICANT INFORMATION, ,4 P Business Name /Type: / 1 f N Previous Business on this site Describe the proposed business, including use, number of employee num er of shifts, ailable parking spat s and any addition 1 inf mation that you can provide: a *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 acc a to the bes n ledge. ave read the conditions of approval, and I understand them, and that Iwill abide by them. "42 Signature Printed 'd O L INFORMATION F,fy roved as proposed [ ] Approved with conditions [ ] Denied prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119. � C6ow Y� loo physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date S Zoning Official Date -6 5 d 8 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 I L 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 VNO Will there be ood 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? KYES ❑ NO Will you be putting up a new sign of any land? If so, obtain proper Sign permit. /� ,joy L S yr7i -J�, Permit # C) , ❑ YES tj� NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Gonin Tech to complete the tonowin : Violations: ❑ YES NO If so, List: Variance: ❑ YES QINO If so, List: VV Reviewer to complete the following: Square footage of Use: kf6'O `T [YES ❑ NO _n r Permitted as: f - Under Section: Supplementary regulati s section: l 11 Parking form &D Required spacpqam L_ _ 6 5V-I, 0 Cu— F-1 YES ❑ NO Items to be verified in the field: Inspector : Notes: rr ers: YES ❑ NO If so, List: ,' Date: � ,�� -�� � SP's: YES ❑ NO If so, List: r 511106 Page 3 of 3