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HomeMy WebLinkAboutCLE200800075 ApplicationApplication for Zoning Clearance ❑ Zoning Clearance = $35 PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY CLE # d 6o- .-,:)1 Check # 6 h. Date: 4 -'t Receipt # 22 P-149 Staff: PARCEL INFORMATION Tax Map and Parcel: QQ 166 -66 _ 66 — 64 CD Existing Zoning )C4 Parcel Owner: ah6b-,h !e, W. ut.^,0 s Parcel Address: 5 's I � r— V-V1t tome— 4cityl5ea 640 Re— State va zip ;aa / (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project9 irG3 a i i `•n a O ° Address: ( i'►'� t $' tt?*!~+ ttij�- City t2 �••F- -State OR Zip2�- � 3 OfficffPlione: Cell# 43 —f Fax # E- mailY "%!a'ias 140tmgt)- APPLICANT INFORMATION Business Name /Type:�� %f'-. Previous Business on this site Describe the proposed business, including use, number of employees, nu er of shifts, available parking sp ces and any additiona i�ifprnpation that you can provide:r''� ° r0 ° mSb r LG%_a$, j !jS�O¢S e� *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 Iwill 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. [ ] This site com lie with 1 ite an as of this date. Notes: I Q e� SL_ •,- Building Official Date `i i •a (i c� '� c .-C-%A- Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McILrtire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of 3 r � Intake to complete the following: ❑ YES O'NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. 0 YES ❑ NO Will there be food preparation? If so, give applicant a I -eal 1 Department form. Zoning review can n e in Lint' we receive approval fiom Health Dept. FAX DATE 0 i ❑ YES ❑ NO Is parcel on pry ewe or public water? If private well, vide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑YES [LNO Is parcel on r public sewer? ❑ YES [VNO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES E � N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Coning 'I'ech to complete tine Violations: ❑ YES 0/O If so, List: Variance: ❑ YES 0 40 If so, List: Reviewer to complete the following: Square footage of Use: 3 n 7 /ES ❑ KNO rt� �' Permitted as: W i 11d Under Section: %O.;z • l Supplementary regulations section: 611('11 Parking form u �: „ + r 2� It Required spaces: ❑ YES ❑ NO Items to be verified in the field: Inspector : Date: Notes: Proffers: ❑ YES ❑�'1�O If so, List: " SP's: ❑ YES ©NO If so, List. . 511106 Page 3 of 3