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HomeMy WebLinkAboutCLE200800220 Legacy Document 2013-03-18Application for onin Clearance�'''� Zv CLE # D Z �' %RGIN�P V Zoning Clearance = $35 OFFICE USE ONLY Check # I% d ,3 Date: 7 d PLEASE REVIEW ALL 3 SHEETS : Receipt #_ 77— 7/0 Staff: PARCEL INFORMATION (-1 e. 14 c�hway �j Tax Map and Parcel: { Qcc e I I A 0 "I 8 00 - O O- O O- O :. 6 C (,Existing Zoning (fin tim rv, r r i n 1 Parcel Owner: Pi Mencw F Parcel Address: j 'soui'h {��v�tn,�c .l Y i V e City 01 )w l0 i£SV i 1 � ,9- State _ Zip (include suite or floor) PRIMARY CONTACT /write this ?r Who should we call concerning project Address � 6 SoLXfk nnfac 'D r. City Nct r 1ol -OsV i 0- State \/A A Zip 2991 Office Phone: Fax # N E -mail _brT�ni APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: C'_nOn (It-e-P CP_ [ate Q i Previous Business on this site " ,^ k h„ J el 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: 2e co -e mnln,4 Pes ° Off,J -IQs •. M W r, 11.60 R M - Ca'.00 f3tii O© 3: (5 ks cs one to Ica s ,! �.�` �, *This Clearanc will only be valid dn the parcel for which it is approved. If y6u cha ge, intensify or move the use to anew location, anew Zoning Clearance will be required. I hereby certify that I own or have the owners 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 ��. P'� � J rri ;tedA�� A —ckxe i So r1 _' APPROVAL INFORMATION L,ol Approved as proposed [ ] Approved with conditions [ ] Denied [ ] 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 et ' Zoning Official -;i Date t'` Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 295 -5832 Fax: (434) 972 -4126 Revised 04/28/08 Page 2 of 3 Intake to complete the following: Y /(N Is us LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/N Wil 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 or u i- If w ? private well, provide Heal artment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic r- public sews Y/N Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the followine: Reviewer to complete the following: Y Square footage of Use: N iitted as: Under Section: 2_q, -i • 1 ( / 1) Supplementary regulations section: a. � s - or Parking formula: �p`�� v ¢ Soy p U.4t'1`6./ 2.. M, %t ) Required spaces: ' Y/ Items to be verified in the field: Inspector • Date: Notes: Viola ons: Y /IY If so, List: Proff rs: Y/� If so, Est: Vari ce. Y/M If so, ist: SP's• , Y /N) If so, List: Clearances: SDP's o:Z - 1 Revised 04/28/08 Page 3 of 3