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HomeMy WebLinkAboutCLE200800102 Legacy Document 2013-01-16Application for Zoning Clearance coot -,�,,, x �/ U Zoning Clearance = $35 OFFICE USE ONLY CLE # PLEASE REVIEW ALL 3 SHEETS Check # ,3 4113 Date: — —F, Receipt # �) Staff: ,,a PARCEL INFORMATIQN ,{ a , �.�bf b v .� Tax Map and Parce . Existing Zoning Parcel Owner: Ave , / Parcel Address: %� City ` State 1/A Zip (include suite or floor) PRIMARY CONTACT Z11614 Who should we call /write concerning this project? &ya ' / Address : � ! /L!yT�! City State 00 Zip L Office Phone: c ate �j "l /` Cell # 10ax# E -mail APPLICANT INFO WN Business Name /Type: .7 Previous Business on this site yaco ij i Za�d Describe the proposed business, including use, nu her 9f emplo es, numb e of shifts, available p rki g spats and any additional information that you can provi e: r 2 .. , *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 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, xl 19. [ ] 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 i ­k Zoning Official Date 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 © /N0 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's ReZNO ort (CER) packet. F-1 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 o riv e 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 10 Is parcel o se -jibor public sewer? ❑ YES NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES 2/No Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Coning l'ecln to c Violations: ❑ YES dNO If so, List: Me 1011owin2: Reviewer to complete the following: Square footage of Use: p 4 [OYES ❑ NO Permitted as: � - * HO-'V- -A 5AOP�rTAA, 6P-7 ' -30 6 Supplementary regulations secti n: At-, Parking ormula: Required spaces: 42--th +' ❑ YES ❑ No Items to be verified in the field: l Inspector : Date: Notes: 5/1/06 Page 3 of 3