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HomeMy WebLinkAboutCLE201300138 Legacy Document 2013-09-19Application for Zoning Clearance °� "'`�� CLE # r C� 1-3 - �� fix. >„ r PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # (, �/� Date: -Z--13 Receipt # Staff: V' i l• PARCEL INFORMATION Tax Map and Parcel: Existing Zoning Parcel Owner: -�1 0��- LL LID -,� C Gl Zip Parcel Address: ms �Gi4'1 J City V1 `I e- State (include suite or floor) PRIMARY CONTACT j Who should we call /write concerning this project? Zip ZZ� Address: 79-76—JbIn u M�0 City. MeAL AAQ State VOL- S Office Phone: (_) •7i`f4 Cell # i� 11 Fax # E- mailra�Pj/-- (�ipCAlnne _ CO P►1 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: � Q S o ft /4-4$ C Previous Business on this site Describe the proposed business including use, number of employees her of shifts, av ilable parking spa s, number of Zov.LS g �nu vehicles, and any tional i f rmati n that you can rovide: C.C� V z T *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 ave the owner' permission to use the space indicated on this application. I also certify that the information provided � is true and accurate to a est of my knowl ge. I have read the conditions of approvalrunderstan them, and that I will abide by them. ✓' 4 i Signature Printed a APPROVAL INFORMATION [ pproved 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 c Zoning Official Date f Other Official Date County of Albemarle llepartment of %-ommunuy Leve,UNuicnL 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: Is / Is usYin LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / N� 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 o public 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 or u c sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # T Y/N Will there be any new construction or renovations? If so, obtain the roper Permit. �7 Permit# UI -3— LLD i�( 1�'a_ Reviewer to complete the following: Square footage of Use: 5,JS?,--2 �1 P P"eimitted as:i1'�2� Under Section: �I alb Supplementary regulations section: rking formula: 6equired spaces: I Y/N Items to be verified in the field: Inspector Notes: Date: � 1 Zonin to com lete the followin 5cho�� �-'' kLJ Viola 'ons: y/ Ifs ist: Pr ers: Y N Ifs ist: Variance: Y/N If so, List: Y N so, List: Clearances: JP � ©� o� SDP's � n� �� Revised 7/1/2011 Page 3 of 3 � C N C N W t r ID W cl m =O O p O p v V O m O N N 'o N m O M M d N u o O CL LL LL QOp O 00 O co G Z Cl) O M N O N V M E d O M O N m O M O co O W M N N N ^ c � N (p N N N O N + N T O N o c C m W U J W U_ Q w d m C E d p N �Ql y y d C W U U p ft3dN- O d' Q N w •N U O LL O O U Q u v 0) 'o j-=. h a a j , m u m ,J Q tn ° ~ F- LL L U � N pN m NNm L L' ~ C E � O 2 cr N dam' O dN' W 7 M V p N F- C � 0 O o U d ` m c > N o uNi C . W C O O O m u N M N 0 c a ° m N K U U� m Y U = � N _ � U L U O r � U N ' O O O M W tC) M O M Ol � N O N J C N a N N N N N N o N d _ y