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HomeMy WebLinkAboutCLE201300009 Legacy Document 2013-02-04s • • Application for Zoning Clearance .G��F ,V.UF. CLE # �� �' . e,r 1. �� /I2L;lN��' OFFICE U LY PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORMATION, ,, -- j �n � � � � Zoning YP l•(.d.Y !� ` � l'J►�� Tax Map and Parcel: Existing ,� Parcel Owner: F/OA_� v Ue/ AMA P / Zi_v '' � I L V IIr � Parcel Address:wu) (include suite or floor) PRIMARY CONTACT 4�, S'l % Z/l� S Who shouldwe call /write concerning this project Address: ( 0 �' ' I © 0 /9'V A ity (_PXf 2/C / 0 7 1r(S S4td'� I/ Zip "2a Office Phone: &.?Z6 q,�O " Ofkell # Fax # E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name 1/New business Business Name /Type: Z_(2 /�GuN • c VePrevious Business on this site Describe the proposed business including use, number of employees, n} b of shift, availabl parking spaces, numb r of l EN16✓i I vehicles and an additional information that you can provide: t_ ffum L *This Clearance will onli be valid on tU parc 1 for whicfi 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 , owledge. I have read the conditions of approval, and I understand them�addthat I will abide by them. Signature g'�' `►� 61✓J2�P/J ' Printed �/ �/ to 7 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, x117. [ ] 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 Zoning Official Date .�_f Other Official Date County of Albemarle Department of Community llevelopment 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 Intake to complete the following: Y /sue Is u m LI, HI or PDIP zonin f so' give applicant a Certified Engineer's Report (CER) et. Will there be food preparation.? f aJl �� 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 r ublic water? If private well, provide He ]th Department form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE Circle the one that appli Is parcel on septic o public sewer? Y /d Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y Wil there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the followin : Reviewer to complete the following: Square q g S footage of Use: 4 U0 " fitted as: Under Section: �VS • a • 1 -1 a Supplementary regulations section: Parking f la- Required �' Required spaces: j Y/N J Items 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 7/1/2011 Page 3 of 3 Application. for Zoning Clearance �1 OF A1.14• r C OFFICE j PLEASE REVIEW ALL 3 SHEETS Cthecic# Date: Receipt # Staff; PARCEL ZN TI0NlTax _ INN Existing Zonig ?W j �)eri� Map and Parcel: 01 Parcel Owner; n—o V& AlUd jj f r t �l l�) 1� City 1 State Zl ' Parcel Address; _ (Include suite or floor) PRIMARY CONTACT Who shouldlwe call /write concerning this project? (i Zip�� Address: l Office Phone: Ly. ?J � �(�O� ell # Fax # E-mail APPLICANT INFORMATION Check any that apply; Change of ownership Change of use Change of name //New business Business Name/Type; Previous Business on this site— Describe the proposed business including use, number of employees, ebb o�fshift , ay.11nb1 ar cingspaces> nu-m, ber of LAMA�i veh ele {nd an a d�onai information that you can provide: l,WM "S"' } *This Clearance will opt be valid on tM part l for Nvhicfi it is approved, If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. , 1 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 Recco6ttee to the best of n y owvicdge, I have read the conditions of approval, and I understand them, arid that I will abide by them. 104 r 0 N a �/ °t U Signature( R''' `� c C Printed / APPROVAL INFORMATION [ J Approved as proposed [ ] Approved with conditions [ J Denied j ] Backfiow prevention device and /or current test data needed for this site, Contact ACSA, 977 -4511, xI 17, [ J 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: B01(ling Official Date Zoning Officlal me i (% o C l/ 20 i s Aat Other Official /..d�L l.ounLy 01 AuJ011111rru pupa' uILUM1 V wuurui+ J .—F ... ­ 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5332 Fax: (43 4) 972 -4126 Revised 7/1/2011 Page 2 of 3 I 1 i I 0 v 0 a, a IZZ a 96.7 0 �V °J T 4,