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HomeMy WebLinkAboutCLE201300066 Legacy Document 2013-05-02N.W 3rd n�ii►n.�.; Application fo CLE # �J r• OFFICE USE QNLY PLEASE .REVIEW ALL 3 SHEETS Check# G. Recelpt # 1G Staff: ./ PARCEL INFORMATION Tag Map and Parcel: ©'•TOO --00 - 00 " 0 ZO F, 0 Existing Zoning t'1 C Pareel owner: C dA P- (-a r Fs ✓i L L r LA,,J 0 L L Q- ' / Parcel Address: 11+11 k(CH�J6 t2p city 4 h(A(,L©t 6' VILLVState- V� Zip ZZ1 r ) (include suite or floor) PRIMARY CONTACT 'V-9 1 C> NSO N Who should we call /write concerning this project? ...ADO Address : 3t 6 Cu4 M I) % W14PT' city KC6WICA State VA zip Z!.1 Office phone, E-mail # �y? Check anv that of own of use Change of name BusinessNameayne: 690WO " RESTAOAVTt" Previous Business on this site r—jopv r-A'� o- C �W E-` V V V► U ' 'New business Describe the proposed business including use, number of employ number f hilts, available parking spaces, number of vehicles, and any additional Information that you can provide: �ST�i ArT" . /O Z W -t<r.� 5 t?R-c 35" 6'M ?�ayEFS 2 4This Clearance will only be valid on the parcel for which it Is approved. If you change, intensify or move the use to a now location, anew Zoning Clearance will be. required. I hereby certify that t 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 t t my Scn6wledge. I have read the oondidonsofapproval, and I understand them, and that I will abide by them. Signature �, Printed &tC S JO 1-yjS JJ APPROVAL INFORMATION q Approved as proposed f ] Apppioved with conditions ( 1 Denied f ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977.4511, x117. f j No physical site inspection has been done for this clearance, Therefore, It Is not a determination of compliance with the existing site plan. f j This site complies with the site plan as of this date. Notes: Building Official Zoning Official Other Official / County of Al ear arle Depf 401 McIntire Road Charlottesville, VA Date Date (434) 296 -5832 Fax: (434) 972.4126 Revised 7/1/2(}11 Page 2 of 3 Intake to complete the following: Y/N Is n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y l,/ N will there be food preparation? If so, give applicant a Health Department form. Zoning review can n t begin until we receive approval from Health D pt. FAX DA -1 I�� 1V'p IBS' ' ircle the one plie s Is parcel on private well r public water? If private well, provide Hea epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap Is parcel on septic r public sewer. N ill you be putting up a new sign of any kind? If so, obtain proper Sign penmi . ^ �, 1 r Permit # , ._L I Lt.1 Y WI SL be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonina to complete the following: Reviewer to complete the following: Square footage of Use: 74// CO /N Permitted as• le-4-A 1W � W,,� Under Section: Supplementary regulations section: Parking formula: Required spaces: r / Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y /q) If so,Zist: Proffers: 6/N If so, List: 9 � y Variance: Y/� If so, st: SP's: d/N If so, List: Clearances: SDP's o y- 9�S 6­7 � s Revised 7/1/2011 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations orAppeals, Sign Permits, Building Permits) if the application is not the owner. I certify that notice of the application, _ AfP L' C ft J/j Rd`- --�G►JI 's -1 0 �,Q-, wcg: [County application name and number] was provided to CGf A� (o u U� (-1 (Ar4 U C the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number U $60 - 0 0 -00 ()? -0 s y by delivering a copy of the application in the manner identified below: L'Hand delivering a copy of the application to b%t'Vra, W/�L is M M&L 00jRwcl a VJ t4e [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on "T L�- 2a 13 Date Mailing a copy of the application to [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date to the following address: [address; written notice mailed to the owner at the last known address of the owner as shown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signature plicant C(Lc <- S J o r1r', S Print Applicant Name ql e /zoo 3 Date mill F. mill ,11 rriviii; I I L e� � a 71 mill F. mill ,11 rriviii; I I L e� � a