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HomeMy WebLinkAboutCLE200800065 Legacy Document 2013-01-11Application for Zoning Clearance /Zoning Clearance = $35 OFFICE USE ONLY "� CLE # ©� (!� Check # _ ; Date: t) PLEASE REVIEW ALL 3 SHEETS Receipt #°T— Staff: PARCEL INFORMATION Tax Map and Parcel: 0 r7 CQ UP - I' 2— Existing Zoning PDM C Parcel Ownerd kA9.. V— t d le, J,i b P 4S 6 (,I GI-i S Parcel Address: S4 *DlhCe11 V-d IiM IDO City _ChcarIORUV1IIe, State V Zipdo�cl (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Loy, Ynoad U Address : 159 G1,yyfri 221 s W4,- 142R City (,kaY )I 6I V, Ile State VM- Zip Office Phone: ( ail S- 5355 Cel #�OQ --Ntoo # �;Yd�- 5 ��� E -mail D Yi . maod a 1�� Cyr APPLICANT INFORMATION Business Name /Type: ��y Ul Yl 1,2l� �Q.LH h D 1 UU 1 e S h -r4 N e, ('are, Previous Business on. this site Describe the proposed business, including use, number of emp yees, number of s .ifts, av ilable parking spaces and any additio al information that you can provide: /7 .V4 6 7 �o M L- C4 eA -74 *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the bern, nowledge. I have read the conditions of approval, and I understand them, and that I will abide by them, Signature Printed APPOVAL INFOR TION [ Approved as proposed [ ] Approved with conditions [—]..Den ie-d � [ ] B�ekflow prevention device and /or current test data needed for this site. Contact ACS , 97PA01dUfjJ$I2)evice a /or [v]# physical site inspection has been done for this clearance. Therefore, it is not a dete miClallti' MftCQHia5 t�etheeoexbsti g site plan. Contact ACSA 977 - 4.511, x 11(19 [ ] This site complies with the site plan as of this date. Notes: Building Official Date Zoning Official Date 3 a $ D g 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 ? 911 9 . CUN 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 ;],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 ublic water? If private well, provide Health partment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑ YES ❑ NO Is parcel on septic nru se wer? F-1 YES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES ❑ NO Will there be any new construction or renovations? If so, obtai the ,p oper P r;ni� Permit # ((�7 Coning Tech to complete the following: Violations: ❑ YES If so, List: Lvj NO Variance: ❑ YES If so, List: 0 NO Reviewer to complete the following: Square footage of Use: Peed as: a CC, Under Section: A3 Supplementary regulations section: pq n Parking formulq:/ b O a Required spaces: ❑ YES QT NO Items to be verified in the field: Inspector : Date: Notes: [YES If so, List: t� dZ� t2 (-e:� S ' YES ❑ NO If so, s °, L: 511106 Page 3 of 3