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HomeMy WebLinkAboutCLE200800077 Legacy Document 2013-01-11Application for Zoning Clearance 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 OFFICE USE NLY r'! El Zoning Clearance = $35 CLE # R-6=b 7 PLEASE REVIEW ALL 3 SHEETS Check # q7g 6 Date: Receipt #. 9-D236 Staff. _IS'r,5 PARCEL INFORMATION Tax Map and Parcel: D6J M - jQ0- DD-'GYo300 Existing Zoning G/ eo1»rne1a;&/ Parcel Owner: -7h✓ee Parcel Address: VI) %rReNiCoe L,JRC %y S� /d3 City Lh,4k Jo/7e.Sw) Je State 1,16 Zip AR 901 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address: i7b lieeMley /_i✓. S4e- 103 City State I1A Zip w Office Phone: erje'�l3- /DS-'S Cell # Fax # E- mail (/yh4ff1S��Cd.r1»IOrVtdPct�a J, G'dr� APPLICANT INFORMATION Business Name /Type: /',j MMQA1aeAA A k i/ /NcY , L L C ejweAee e4 Previous Business on this site �)e)e9a UL 4- mll .Sent/ /C eS Describe the proposed business, including use, number of employee , number of shifts, available parking spaces and any additional information that you can provide: 11ye&6 D- lce /3 --r7. vf'e 5 - G,�Pri x AW9,rr6Dt}Ce5. *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•thee best of my laiowledge. I have read the conditions of approval, a�nddII understand them, and that I will abide by them. Signature GL,2.C�'•!!/LdO� Printed /�1C�0/21i1 �• �%�2�2)S APPROVAL INFORMATION [V] 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 determ=Cunent liance with the existing site plan. w Device and/or [ ] This site complies with the site plan as of this date. Test Data Needed Notes: 97745!1, x Building Official c ~- Date L4 Zoning Official ) Date LAY //0 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 511106 Page 2 of 3 Intake to complete the following: ❑ YES [?I'NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES []ENO 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 4c ublic 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 ublic sewer? ❑ YES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES Z NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonins/Tech to complete the followin Reviewer to complete the following: Square footage of Use: cl YES ❑ at Permitted as: (/ki see Under Section: -1-LP' P' 1 X-1 Supplementary regulttans section: Parking formula- Required spaces: q ❑ YES ❑ NO Items to be verified in the field: Inspector• Notes: Date: Ba'tions: YES ❑ NO If so, List: p i Proffers: ❑ YES ❑Q NO If so, List: n VJ f 10 y �. Variance: ❑ YES ❑ / If so, List: SP's: / ❑ YES ./❑ NO If so, List: 511106 Page 3 of 3