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HomeMy WebLinkAboutCLE200800221 Legacy Document 2013-03-18Application fo vv nin Clearance CLE # I =�� °;`gym U �1R(:lN \P ing Clearance = $35 ZonVIEW OFFICE USE ONLY Check # / D 5. Date: Receipt # Staff: PLEA ALL 3 SHEETS PARCEL INFORMATION '71.12 HC Tax Map and Parcel,,: 07TOO -' 00 - 01 Existing Zoning Parcel Owner: J5eyyj JMyr\A 1l'7A11 Parcel Address: /26 Ayeg J Dr * 4 City / J 1/1 � State VA Zip Z� (include suite or floor) PRIMARY CONTACT �� =Mg SXHIEE514 Who should we call /write concerning this project? IJ�L Address: aQ" 1/6 Geek DY City y� VI'G State zip 2 ,3 Office Phone: 2 4ol, 1 Cell # Fax # E- mail�t,��VNel� l •CD APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business lflafAyaw-e Business Name /Type: Y t 6 S Previous Business this � �TC� C on site /!!Dy►L 1IITU'YGl1Aee Describe the proposed business including use, number of employ es, number of shifts, avai ble parking spaces, number of vehicles, and any additional information that you can provide: 70JUY4Mte �1eS 01tdSCY1 1W 2e o s. p,,,,,��� as . I1 t�aykty►a *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 accur�ebest knowled ge. I have read the conditions of approval, and understand them, and that I will abide by them. �I Signature Printed PAY 5,+ _ -f9LrS /f APPROVAL INFORMATION Approved as proposed j' ] Approved with conditions [ ] Denied [ ] Bacicflow 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 i 1 J o'er Zoning Official Date Other Official Date 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: Y / I) Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /I 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 o ub If private well, provide Healt 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 ublic sewer Y /NN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. ©qty O-4 e pAn s4u�v► Permit # I Pthere Wi be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: %!) d a N fitted as: i nsi Under Section: %,5. 2 —, Supplementary regulations section: Parking formula: (� J j Required spaces: Y/ Items to be verified in the field: Inspector Date: Notes: Viol ions: Y /'� If so ist: Proff s• Y/� If so st: Vari ce: Y/ If so, List: SP's: Y/L If so, List: Clearances: U —7 _ I UZ SDP's -X-- Revised 04/28/08 Page 3 of 3