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HomeMy WebLinkAboutCLE201300081 Legacy Document 2013-05-03Application for Zoning Clearance %'` PLEASE REVIEW ALL 3 SHEETS OFFICE U QNLY } Check # 1 Date: ° 1 Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: j 2- , /60 Existing Zoningi.w '� Parcel Owner: .14"'1�o�'J� Parcel Address: ©c) eA LcX:' -f) Cit4 W j U ijl4, State UPf Zip 2L90) (include suite or floor) PRIMARY CONTACT /l Who should we call /write concerning this project? COQ �9 nll� set if Address: 6600 City W%' State ZipZ3g°��- Office Phone: Cell #<�CA-M 23%-�'Fax # E -mail 56,,4 11 (1 Q GL Y C O > APPLICANT INFORMATION Check any that apply: ✓ Change of ownership Change of�use C1 of name New business -hange Business Name /Type: Sc'"Lo 7l Iq o L b SjXv)\ -' p- Previous Business on this site ] n r _S 1h n K% +s,(S L 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: �j�.� 2'P_^+a l LX-rQ±;Nn & 'y" f, 10:1 @.1 s 3 Shits 3(� TA2Kina_ S-lA)1 -f *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 wn or have th owner's permission to use the space indicated on this application. I also certify that the information provided is true and accura t the best of my nge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printedn e�b/ APPROVAL INFORMATION 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 , Date Other Official Date County of Albemarle Impartment of t_ommunitiy Leveivpuic„L 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: Y /0 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/(:g 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 r ic water If private well, provide 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 septic o ublic sewer9 Y //TV Wil you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper Y //1�,3 Wi ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoninf, to com lete the following: Reviewer to complete the following: Square footage of Use: :?ou Gou-d —l' V/ N Permitted as: �I�e��y To Under Section: Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector: Notes: Date: Violations: Y/N If so, List: /{ Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDP's �+ Revised 7/1/2011 Page 3 of 3