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HomeMy WebLinkAboutCLE200800140 Legacy Document 2013-01-17Application for Z©nin Clearance CLE # �06 Zon ng!Clehrim PARCEL INFORMATION Tax Map and Parcel: (� Parcel Owner: -2.," L (_ -2 rP� Existing Zonin2r P.0 Parcel Address_ / !�: CIO U-715 r li ` City )V JIL k State (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? R1 r- r C,• ,`i6V6 /V P1 4-(116s F Address : 6 1 10 A f City U SYb-6y9S 'II Office Phone: U Cell # Fax I APPLICANT INFORMATION Zip �i 40 _ff'efJtl- State VA Zip �� q o 1 E -mail C f! Business Name /Type: x y e rt [+% , "' oln a j ,Z m t ,,t pup; QC_ Previous Business on this site ho h 2 Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: 5-uV, `Le. v l i n c It ( P nV'4- y tM e_At Gl j y3dQ 6^C pr_rf._ Oat V'��►hCte *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. z- r te - s U � Z / L'I t✓ Signature Az- ,— �/ Printed 1 yEN J Backtlow prevention crevice ana /or'current test aata neeaea for mts site. No physical site inspection has been done for this clearance. Therefore, it site plan. [ ] This site complies with the site plan as of this date. Notes: s not a deter nination of compliance with the exist', Building Official �_s�z Date- ; 1 Zoning Official Date. Other Official Date AM County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 04/28/08 Page 2 of 3 Intake to complete the following: Ylf Is use I, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /UN' 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 Circle the one that applies Is parcel on private well or Ryhlic matPr9 If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or public sewer? Y /t% Will you be putting up a new sign of any land? If so, obtain proper Sign permit. Permit # Y / Will sere be any new construction or renovations? If so, obta' t r r Pe t/ Permit # Zonina to complete the following: Reviewer to complete the following: Square footage of Use: A Pv x 13 0 S' ermitted as: AZ —t .G Under Section: 5-A • ( Supplementary regullations section: 0, IBC Parking formula: i%�-0n '(A Required spaces: Y It to be verified in the field: Inspector: Notes: Date: Violations: Y/N If so, List: Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3 130