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HomeMy WebLinkAboutCLE200700141 Legacy Document 2013-12-13Application for X11"Zoning Clearance ON,, `,� ,, 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 EIN ,net OFFICE USE ONLY Zoning Clearance = $35 CLE # weir# 1 Date: PLEASE_ R_ EVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: 0I w co " C) Existing Zoning i /�� Q h 5 6 r L Parcel Owner: Parcel Address: �'�� S "`I City f State Zip`�� / (include suite or/fl'de�) , ���[[dd�� PRIMARY CONTACT Who should we call/write concerning this project? Address : a 1(% a ryi l n I o n etj I \G Y City u r ari qbk, State VA Zip 2 5�a R.Ik Dr4� l� rJ Office Phone: � �-02 ®Cell # —� Fax # E -mail n ION APPLICANT INFORMATION Business Name /Type,: Previous Business on this site: Describe the proposed business, including use, npi;nber o� employees, number of shifts available parking spaces and any additional information that you can provide: *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 pennission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowledge: I have read the conditions of approval, and understand them, and that I will abide by them. )I Signature -- Printed K A IV APP ROVAL INFORMATION [ Imo] 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 detei7nination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date iz� Zoning Official Date 'iS Q 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 EIN ,net . tf Intake to complete the following: ❑ YES X, NO Is use in L1,-HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES NO Will there be ood 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 OYES ❑ NO Is parcel on septic or public sewer? YES ❑ NO ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YES 10 Will there be any new constructiop or renovations. If so, obtain the propeyP ij. � / '� Permit #A5Q7" �C�/�� roninLy Tech to complete the following: Viol tions: RYES ❑ NO If List: 016 ivy bo-fj Gt- Variance: ❑ YES 0 NO If so, List: Reviewer to complete the following: Square footage of Use: $7 (o DYES ❑ Permitted as: nn � Under Section: �(o�• a ` f °�` Supplementary regulatio�s�section: Parking formula: LiU � ,A Required spaces: (,. � � bxIA� ❑ YES ❑ NO NO Ite !to b verifaed in the field: A Inspector: Date: Notes: Pro rs: LV YES ❑ NO If so List: sr7: © YES ❑ NO If sg� ist,: J I (A-- 5/1/06 Page 3 of 3