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HomeMy WebLinkAboutCLE200600300 Legacy Document 2013-12-09Application ford =]y. � Zoning Clearance k OFFICE USE ONLY /, 94o'ning Clearance = $35 CLE # 00(p 30 a PLEASE REVIEW ALL 3 SHEETS Check # Date: — 16-0(,0 Receipt # (Q{ Staff: In PARCEL INFORMATION Tax Map and Parcel: 6 b L '`�! b D '�0 2 j f%� Existing Zonin�_� Parcel Owner: Af, 4 o- 9 L LC.- Parcel Address: �,— ? 9 P S� y o - e City ,,f p41u3 a suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? _ Address : Po gOc�, ] �' Office Phone: 3� �$'% l Cell # APPLICANT INFORMATION Business Name/Type: Previous Business on this site ©k 1....rU State VA_ �o��• }Aegeu Zip ? Zq 3' City State Zip Fax# E -mail C_�1o.r�9TSCi� +[1�� L. Describe the proposed business, including use, number of employees, number of shifts, a ailable parking spaces and any additional information that you can provide: P C' s, *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 the best of my ledge. I have read the conditions of approval, and tI understands them, and that I will abide by them. Signature Printed 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, 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. Building Official a Date .Zoning Official � Date 1.2, Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434).296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of 3 Intake to complete the following: ❑ YES al Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) cket. ❑ YES O 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 ❑ YES O Is parcel on private well or public water? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE �14'ES ❑ NO Is parcel on septic or public sewer? ❑ YES 16Jz�sO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES O Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Tech to complete the Q( YES ❑ NO If so ist- 145 Variance: ❑ YES dNO If so, List: Reviewer to complete the following: Square footage of Use: i l- 60 YES ❑ N&C-e, Permitted as: Under Section: Z. 0-1 f l 1 J 1 Supplementary regul�ions section: 1VA1I a Parking formula: // 0 Required spaces: n/ ❑ YES ❑ NO Items to be verified in the field: Inspector Notes: Proffers: ❑ YES NO If so, List: SP's: ❑ YES 0 NO If so, List: Date: 5/1/06 Page 3 of 3