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HomeMy WebLinkAboutCLE200800255 Legacy Document 2013-04-05CON Application for Z ping Clearance ���s,��`' CLE # Z1152— °' '� ' ��RrtN�r OFFICE USE ONLY Date: G 0 x Zoning Clearance = $35 PLEA REVIEW ALL 3 SHEETS Check # 116 Receipt # -70 :%/ Staff: PARCEL INFORMATION Zoning Tax Map and Parcel: ,�/ h�Exiissting e Parcel Owner: / Y e� ✓Z7 �d — y ii 1 �, - State VEA, Zip L2 (4-1 Parcel Address: I bb u o city Gh��✓ 0-t -kes (include suite or floor) PRIMARY CONTACT � �/ /� ��� j //' V A 6 Who should we call /write concerning this project? / /�(iI�%1 C ES �PN.P�^ i�(� l�, J 1 t7 b City 51 a lit')? �O V1 State VA Zip Z Address : / Office Phone: Cell # 434 `t�ON-4f # E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: �13 f 5t el E 11 7 Previous Business on this site F 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: *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 thee best of my knowledge. I have read the conditions of approval, and I under�s'ttandl them, and that I will by them. /abide lV yd YA /'(1- © 1A Printed % Signature AP 120VAL INFORMATION [ ' Approved as proposed [ ] 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 1 dJ�l /�� Date Zoning Official Other Official Date County of Albemarle liepartment or t;ommunity LeveiuNiuciu 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 / / Is u m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /1/ Will re 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 �}Ibllc wa r? If private well, provide Health�ep rtrnent 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 glrtic sew r? 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 anKro"Poellitt, ction or renov ations? If so, obtain t . Permit # th T-11 OWl 'n Reviewer to complete the following: re footage of Use: N��� fitted as: Under Section: gg. �-' Supplementary regulations �ection: Parking formula: t /_ O P" Required spaces: -F5 A, Joe P141 Y / N /mil l_�1� Items to be verified in the field:_ Inspector : Date: Notes: //�UHJU w UUM ILUM e 0 rM Violations: Y If PList: Proffers: Y /e If so, List: Vari ce: Y / If so,ist: SP's: Y /_Z. If so, rst: Clearances: SDP's Revised 04/28/08 Page 3 of 3