The URL can be used to link to this page

Home My WebLink AboutCLE201300073 Legacy Document 2013-04-240 b iv y Y Application fo onin Clearance °Y "`�'` ��rl �1 _ CLE# ,, Y(iGIN1'' OFFICE USE O Y �]] %' M.115 �� PLEASE REVIEW ALL 3 SHEETS Check# Date: Receipt # Staff: l PARCEL INFORMATION / Tax Map and Parcel: �D ©" Q� �0 - ��/C) Existing Zoning P// 2 Parcel Owner:��"� a4�v(-' wllltl Zip Parcel Address: City State (include suite or floor) PRIMARY CONTACT T14G0� go�12/11,17� Who should we call /write concerning this project? �r f// / p�10� r�.�d �s�2r�� `� City/ '(e4; dI16 State I/ Zip Address: Address: �a� %6 —i7KJ cell �� L-(37 Office Phone: �� 9�' Fax # E -mail APPLICANT INFORMATION Check any that apply: _ Change of ownership Change of use Change of name New business Business Name /Type: 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: 161�il �Iz1 *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 pe i sion to use the space indicated on this application. I also certify that the information provided is true and ace to to he best iy kn led . I ve read the conditions of approval, and I understand them, and that I will abide by them. Printed 6 ��U/UtT�� Signature APP VAL INFO ATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow 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 Ah Date '5�/2c/�?�,�'� Other Official Date County of Albemarle Impartment of k ommun►iy LeveloNn1c11u 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 o Intake to complete the following: Y / Is us LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / I Will 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 ubli ater? If private well, provide Health Depa form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE Circle the one that appli Is parcel on septic or p blic ewer? Y / Will be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/�Ibe Will any new construction or renovations? If so, obtain the proper Permit. Permit # Reviewer to complete the following: Square footage of Use: �L6 0 6) / N Permitted as: re4-711 Under Section: -7—.5• Supplementary regulations section: Parking formula: pj)jL y15 av i1 Required spaces: Y/ Items to be verified in the field: 0 Inspector : Date: Notes: Violations: d/N If so, List: n r6 (/ Proffers: Y/(�D If so, List: Variance: /N If so, List: 93--L/ 91s: /N If so, List: 09W3/ Clearances: SDP's < < Revised 7/1/2011 Page 3 of 3 ;a I