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HomeMy WebLinkAboutCLE200700102 Legacy Document 2013-12-12Application for Zoning Clearance Al.,;,, it Lo U ✓rl v1 o F A I he w+.c� i � OFFICE USE ONLY oning Clearance = $35 � 7 CLE # 200 7 PLEASE REVIEW ALL 3 SHEETS Check # i O 1 r' Date: -Z U 7 Receipt # (4) `i/' 7 C! Staff: PARCEL INFORMAprT�ION J� Tax Map and Parcel: (� 7 06) `° 60 — 0 ()_ Q f✓ / / Existing Zoning �P fl:)�s �. Parcel Owner: �P_ ,./ f to Swn; -t L- j Parcel Address: 1a J I� -i�1�✓ i� �! �e' City Ckjq' 164-40 V Je_state V A- Zip zzq H (include suite or floor) PRIMARY CONTACT F. Who should we call/write concerning this project ? C e:-S Address: Z I'2-� i-0�i �� C it -G(�- City 6A k. - ioe4cs— i`l /State VA- Zip �L�IaI 3+i Offce Phone: C ±2A) Zq Z ZCell # Fax # 2`13 '5bi� E-mail E -mailnarkq% i A) APPLICANT INFORMATION BusinessName/Type: �ko- ✓i©44e—SVW.e_ e�,Gt ✓,o ✓TL,�rae LLB_ L- l--G Previous Business on this site Pk' A-V ' C_ k.v-i-; n' pt"D , Sh e- 'Is Sri 'L Y"� S7lit.t.� Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any additional information that you can provide: l b, e W L, e'rrC_ -I- {�CiirSC c� S v�b e:-r i v � CGS i'l-f� � -1-r� SP 1-�- err, (a[.v- ©W ;-,� ✓- �� L-t-G . Ti- .Pir-�. � *This Clearance will only be valid on the arcel for which it is approved. If you change, intensify or move the use to anew location, anew Zoning Clearance will be required. I hereby certify that I own o ave the owner's permission use the space indicated on this application. I also certify that the information provided of my know edge. ave read the conditions of approval, and I understand them, and that I will abide by them. is true and accurate to th�ej -T-k kA—"'(AL Signature l'l W—"'(A Printed r—r . n r, S p o ✓ ri G{ + 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. Notes: Building Official Date 3 Z Zoning Official Date D Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 511106 Page 2 of 3 Intake to complete the following: El YES TO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CE )- packet. ❑ 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 NO .- 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 [�YS LJ NO Is parcel on septic or public sewer? ❑ YES NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YS o Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Coning Tech to complete the followingL: Violations: ❑ YES No If so, List: V�a.,�r' ce: [E YES If so, List: 1 °Iq5 ❑ NO -aa i�R-7 - g Reviewer to complete the following: Square footage of Use: [✓YES ❑ NO r Permitted as: nn �� -t, 0 Under Section: y✓ A-, a - l Cl Supplementary regulatiops section: Parking fo7 0 d / z) Required spaces: ❑ YES UNO Items to be verified in the field: Inspector : Date: Notes: SP's: ❑ YES G❑(NO If so, List: 511106 Page 3 of 3 OD TN g� N � N s� � O sue;, ��a, ij g� N � N s� � O