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HomeMy WebLinkAboutCLE200800090 Legacy Document 2013-01-11if .,Application f ®r ��F��'y�� ,Zoning Clearance`.,; OFFICE USE ONLY Zoning Clearance = $35 CLE # q -9 PLEASE REVIEW ALL 3 SHEETS Check # ® � Date: i4.__72 Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: L l rNJ U V 00 & Existing Zoning Parcel Owner: � :G _A.. C .5,- n.a -,rte Parcel Address: � Fl e, • Z_ • City C/h r State U.6, Zip 2ltia l (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address: c Zip �1 Office Phone: Cell # 9 LCv 117Z` Fax # E -mail. APPLICANT INFORMATION— Business Name /Type: Previous Business on this site C�( Q,$ S i (_ Describe the proposed business, including use, number of employW, number of shifts, available parking spaces and any additional information that you can provide: S'C"LA *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 o 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 t, e est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them: Signature Printed A ✓L &-c_- ��- APPROVAL INFORMATION [ ] Approved as proposed [vl"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 s�' e com' p4es with t sit�e �l^an as of this date. �/ Q ^ Notes: l!�.�rn^ , W l klu col" �`- �'?jy�S � r!'�'< %eta ou . ., ,0 rte' L, Building Official Ju Date '- � a -a F Zoning Official ✓�'�✓ �" Date D 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 ` n Intake to complete the following: ❑ YES ©,960 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES 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 public water? If private well, provide Health Departmen orm. 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 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, obtain the proper Permit. Permit # Zoning "Tech to complete the followin2: Violations: ❑ YES ❑ NO If so, List: Variance: ❑ YES ❑ NO If so, List: 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 : Date: Notes: 5/1/06 Page ,3 of 3