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HomeMy WebLinkAboutCLE200800113 Legacy Document 2013-01-16Application for ,honing Clearance I [ ]Zoning Cleat mice $3.5 OFF ' "F U$ O L T 9 Clie�lt # i E,G'��? ,Date PLEASE REV;IE PARCEL wlNFORNIA.TION Tax Map and Parech ©Lol"tcc o 0C> �`y1 C� - 0 q 5 LVO_ Existing Zoning—.-,. / Parcel Owner: _�9S�L? ! S � a �� t5 C V � t �`t V�l� �y c�'N � i(1`T' e.7 Y� p" ;.�° vl �(-t Parcel Address. eN L\-Le S'I-t,y -o r'S A � Z., City C 64— EI ,-S Ui I� . State - _ Zip 2! (include suite or moor) PRIMARY CONTACT Who should we call /write concerning this project:? Address--3-,75 M dirt K tv 1Z _ City C4 e' u S1✓/ P state V - -- Zila Office Phone; Cell # -7-3 1-t2- \ Fox # -LIA ��7��ZCy F -trail � (c� / l e VI C- I Y, car e dl.' APPLICANT INFORMIAMON _ Cliecic arty titat.Apply_ Cha. nge of. vttet 51i p _ ._' Change ttj irse Ghange ii9 n 2na� _. N`eev bus nesfi. Business Naute /T),pe: rJ�1 tr b c1e - GI,J- "✓ - BIZ /DC) c 1 Previous Business oil this site ar Describe the proposer biisiness including lase, number of cimployees, natmbei- of shifts, available w. -Fulig spaces, nuxuhea' f vehicles, and any additional information that you can provide: "`This Clearance will only he valid on the parcel for which it is approved. li'f you change, intensify ot• move the use ie; :1 ncly location, a new Toning Clearance will be required. I hereby certi fy that l Own or have the owner's to use tlic space indicated on this application. T also cclli fv 11?ni the infomiation provided �peerrm��ission is ia'uc and acct, ' e n t1'C be I Filly knowledge. d e. I a.vc read the condition; of appr`ova'l, and T Understand them, and Jim i will abide fly fliem. Signature Z7 (•�J Printed y�l e �Z . � UfO wGye- .1 APPROVAL INFORMATION _..- A.pliroved as proposed r1;PPMV.ecl vrttll cofidItions�T [ ! i.�cniccI 13ackf7ow prevention device and/ 01, cu2teitt:test clatauceded fo211tts;slte CcYt(act ASA, 9 j'�.4511, x i l'). [ J No physical site inspection has been done -tb tivs'.clea2aitce. Thereiole ii is.trot a cietet2nn ltto i oft <n;�pliancc rVith the e istttig' Site plan. [ I This Site coltlplieS with t11C Slte filall a5 Ofth2S d atPV . NoteS` Building Official Zoning Official .� s� �l�t% fit, • Ddte �� ,��� � .._ Other Official D ate .. ti.V11444•Y VII'4"AJ4:maxAu Isepaa'LanentofCommunity Development 401 McIn ire Road Charlottesville, VA 22902 Voice.. (434) 296 -5832 F= (434) x,72-4126 T:r.vigccl 04/28/08 Page 2 of 3 q -7,1 � 4 ►(hAkv, (�K64gwkllo ~-•Y ?�/v Intake to Complete the following: Y/O is use m Li, ITI or PDIP zoning? if so, give applicant: a. Certified Engineer's Report (CBR) packet. Y /O Will there be food preparation? If so, give applicant: a Health Department: form. Z,onittg review can not begin until we receive approval from Health Dept. FAX DATE - -- Circle the one that applic.. Is parcel on private 11,111 pur? Tf private well, provide TTea : nt form. To ning review can noi: be gin until we receive approval from Health Dept. FAX DATE ___ Circic the one that ; is parcel on septic • Qublic s I Y� � Wlll you be puti:ing Lip a new sign of any kind? If so, obtain propel- Sign permit.. Permit # V/ -N Will there be any new const.ruct.ion or renovations? If 'so, obtain the proper Permit: Permit 4 _ Z21) 11L 9 i:o coanplete the following: Vioiat: "ntts: Y/N VaAQ1 ice: Y / is %: Cleaz•azzccs: 6 • --� A 1-3 Reviewer to complete the iz I- S quare footage of Use: 3 Sb 0 ._. Y/N Permitted as: o � Under Section: 15J /9 95— �' I Supplementary regulations section: Parking formula: /' db Required spaces: J Y/N Tt:ems to be verified in the field: Inspector Notes: Y doffffus. st: SP's; Y/N If so, List.: Date: SDPIS Re; iced 04/28/08 Page 3 of