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Home My WebLink AboutCLE200800084 Legacy Document 2013-01-11Application for Zoning Clearance i `r _� r �rrcK r ❑ Zoning Clearance = $35 OFFICE USE ONLY CLE # 60!F— PLEASE REVIEW ALL 3 SHEETS Check # t66a Date: 1h o Receipt # 763'J Staff: 75 PARCEL INFORMATION Tax Map and Parcel: D "60 — 1.a ' 60 Existing P j 5c_ �Zoning Parcel Owner• UUyjp k i� 5 Uax 1G� L.L!�__ Parcel Address: c a& k'50 ( kState k Zip o`odgc)l (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address: 1 y 5cn hQ51rCM,e_ P City State `/i�} Zip Qc)l �o Office Phone: (5 � ( �� °�� a E -mail .rl cO�01 iv5c)n QP__ (eOq&(P (pg 1(V1�ssa�e en�Y, Cc�v� APPLICANT INFORMATION Business Name/Type: (Q SS a n y E�n rinA 4 1 ULQ Y!Lf2C,61C, IIL�(k 55 Previous Business on this site g n Describe the proposed business, including use, number of employees number of shifts available parking spaces and any additio 1 information that you can provide: V k� hc)i7_, l NiYVC Z--,- 7t Or --'' t yi *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 I will abide by them. Signature ��jL�/� --""' Printed e,,,a (fib 17Q5,,iyn APPROVAL INFORMATION ;j';A�"pproved [ as proposed [ ] Approved with conditions . [ ] Denied [ ` Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119. PI 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 complies with the site plan as of this date. Notes: Building Official Date i Zoning Official Date 0 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 t6 complete the following: ❑ YES NO Is use in LI, or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified ❑ YES NO 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? YES ❑ NO ill 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, obtain the proper Permit. Permit # Zoning Tech to complete the following: Reviewer to complete the following: Square footage of Use: ❑ YES ❑ NO Permitted as: Under Section: Supplementary regulations section: Parking formula: Required spaces: ❑ YES ❑ NO Items to be verified in the field: Inspector Notes: Date: Violations: ❑ YES NO If so, List: Proffers: ❑ YES NO If so, List: Variance: ❑ YES [7 NO If so, List: SP's: ❑ YES ["NO If so, List: 5/1/06 Page 3 of 3 Intake to complete the following: ❑ YES NO Is use in L&or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES NO Will there 80od 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? YES ❑ NO ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # 'WYES ❑ NO i I there be any new construction or renovations? If so, obtain the proper Permit. Permit # i ech to Violations: ❑ YES ❑ NO If so, List. Variance: ❑ YES ❑ NO If so, List: the Reviewer to complete the following: Square footage of Use: v OYES ❑ NO `•• ,n, II Permitted as: he 6Z) V� Pry t Gel Cle Under Section:' 4 �) . )- - I Supplementary regulaf(ions section: w a Parking form Required spaces: 5 & ❑ YES ❑YES NO Items to be verified in the field: Proffers: ❑ YES ❑ NO J SP's: ❑ YES ❑ NO If so, List: 511106 Page 3 of 3