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HomeMy WebLinkAboutCLE200800076 Legacy Document 2013-01-11i Application for Zoning Clearance .�`oF nrvE,t OFFICE USE ONLY j Zoning Clearance = $35 CLE # ( �� PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # �(�l0 %, ( Staff: PARCEL INFORMATION , �^p A� l� Tax Map and Parcel: al,l�'- 6-M "Ogff) Existing Zoning Parcel Owner: JAM4l _7( %lCLA,t5 Parcel Address: 0656 (ZeLl", (A) 1-16M wIf City _U07-5--r (include suite or floor) State VA Zip 2-74 3 PRIMARY CONTACT _4_11 . Who should we call /write concerning this project? _J A ,N E%i Address: 60'b j o0 /, I A) �lG wT- 1"Lo e c City CK0 -efr State Vh Zip -? 3 2 Office Phone: 4 3 9 V - 0 01 Cell # Fax # E -mail (�C G h c� (� ► S @ � rykai 1. Cb a APPLICANT INFORMATION Business Name /Type: AKRSi-I A LLC Previous Business on this site Nl o ti-CR (!d LI 6 LNf Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any additional information that you can provide: &—A� 1%u.ti- 4 *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 pennission to use the space indicated on this application. I also certify that the information provided is true and accurat to the best of n y knowledge. I have read the conditions of approval, and I understand them, and that Iwill abide by them. Signature Printed -JAAI T ti'oLU'S APPROVA INFORMATION [ ] Approved as proposed [ Approved with conditions [ ] ied [ ] 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 sitepo plies with the site plan as of this date. r Notes: �/ /� Cd YYV I��(Q u ra J2C S a,2 �e_4.A 102 vV Building Official Zoning Official Other Official Date 41 (k '.� Date 'x/ L6 -/o I 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 Intake to complete the following: ❑ YES 4 NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES 5/ 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 o rivate w r public water? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE iYES ❑ NO Is parcel QZILZ ic - public sewer? dYES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit# l! ®�inl� 1 ❑ YES NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # !onina Tech to complete the following: Violations: ❑ YES dNO If so, List: Variance: ❑ YES NO If so, List: 0 L.4 cl q 3.3 a- M o wwn- 40-/VA. kt Partz"f Reviewer to complete the following: Square footage of Use: X660 YES ❑ Permitted as: C� Under Section: Supgle s ttregulat' ns sectigr�: Dm Parking formula: v Required spaces: ❑ YES NO Items to be erified in the field: Inspector : Date: Notes: Proffers: ❑ YES YNO If so, List: SP/ s: Q YES ❑ NO If Mt: G r Wr k� 511106 Page 3 of