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HomeMy WebLinkAboutCLE201300054 Legacy Document 2013-04-02Application for Zoning Clearance CLE ,154 1*- PLEASE REVIEW ALL 3 SHEETS OFFICE LY ✓✓��,, -# Date: Receipt # Staff. PARCEL INFORMATION_ _ (ze m�/j� Tax Map and Parcel: w i U Existing Zoning I � w m Parcel Owner: 5 M �0?-- LAW -7&V 5'.- Parcel Address: 30'1&A 13M JL lit W�-- b& City CU ILL C- State LIP Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? in-4r 126- Address': a 3 3 0 Pfd [ C4 Or City C 'U1I -L r- State 1/A Zips l� 4( 3-F Office Phone: C__) A[ LA Cell # r i 7' q.2 Fax # Ai[A E -mail m 14AY Y� L()AIV iF P—&42 �S G' YA -1400 . C6114 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name A New business Business Name /Type: C gW F-5 e 3 ob Y Lo CA 14 L L Previous Business on this site 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: Ace, u P/Z ASS v12 � / M.4-55 n 6 ec �1 Si4w-Ts , 1= oZt�itr POLKA16 y / —,a li.r-fitCLms i b2 -3 � "LPL.6 'gk_, � *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. Signature vw`nl i % VI/ (2/'� Printed VA iv 14© q G W ik A APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ .] Denied [ ] Back-low 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 40 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 7/1/2011 Page 2 of 3 Intake to complete the following: Reviewer to complete the following: Y / N Square footage of Use: / -7 Is in LI, HI or PDIP zoning? If so, give applicant a Certif ed Engineer's Report (CER) packet. -0 / N Y n(N Permitted as: /►'1 e.(,� � �,�j, ()-��j{.� Will t ere -be food preparation? -- - - -- - - - -- --- - - - - -- Under-- Section: - - - -- If so, give applicant a .Health Department form. Zoning review can not begin until we receive approval from health Supplementary regulations section: Dept. FAX DATE Circle the one that applies Parking formula:/ O Is parcel on private well �meni' If private well, provide form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE / \ Y Circle the one that applie Items to be verified in the field: Is parcel on septic public sewer I Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit Permit # Y/N Will there be any new construction or renovations? If so, obtain pr er er 't. Permit .4 Zonino to comnlete the following: Inspector : Date: Notes: Violations: Y/ If so`r,ist: Proff rs: Y /fv If so, List: Vari ce: If ifs ist: SP's:' Y / If so, ,01 ist: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 f-�o A