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HomeMy WebLinkAboutCLE200800174 Legacy Document 2013-02-19Application for Zoning Clearance CLE # OFFICE USE ONLY [� Zoning Clearance = $35 Check # Date: PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: OLI7 C C)- 03 °- 0 0— 606 Is © Existing Zoning G Parcel Owner: ;t6cick tS' ►er ! a 2 Parcel Address: 'IZb 6ckta e,S %1VU , 1iY,4 /l3 9 16 City Cln�r� °�� "'' (� State � Zip Z 9 O Z (include suite or floor) PRIMARY CONTACT 1 oeld I�eedhe, y.,, Who should we call/write concerning this project? Address : -7 �' Je L"� J ✓� A) City �A d��L State Office Phone: (y3 D 9&1-6 03 L/ Cell # 9 F[-UO3'/ Fax # E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business �� r} � y c- Y 4 � �,� l 1,.� y Business Name/Type: J . ) l� Previous Business on this site A 'I V y l P Describe the proposed business including use, number of employeeArpumb9r, of shifts, available parking spaces, umber of vehicles, and any additional information that you can provide: *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 cer* that the information provided is true and accurate to the best o y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. ✓ �Gt Printed )d / y (f led � (A Signature APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied IV[/ , 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 site complies with the site plan as of this date. Notes: Building Official Date' 3) Zoning Official . °" Date Z0 Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126 Revised 04/28/08 Page 2 of 3 Intake to complete the following: Y < Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /Iii Will ere 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 lic wat If private well, provide Health apartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic lic s Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. r� Permit # I Y/N Will there be any new constructiorr'or- renovations? If so, obt " o r Pe t. Permit # �" ' � .0 Zoninv to com lete the followin : Reviewer to complete the following: Square footage of Use: 1/0 `;� 0 /N ` ermittedas: 1 c tsc�jn �nl 6�r1UZ/ Under Section: Supplementary regulations section: Parking formula: 460 1V.t Required spaces: . Is Y/N Items to be verified in the field: Inspector • Date: Notes: Violations: () /N If so, List: J'J Proffers: Y If so, List: Variance: Y/ (IT) If so, List: SP's: 0/N If so, List: Clearances: SDP's o�- X91 6-7 04ir - 9� Revised 04/28/08 Page 3 of 3