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HomeMy WebLinkAboutCLE200700144 Legacy Document 2013-12-30Application for "t Zoning Clearance" Aix" OFFICE USE ONLY al-oning Clearance = $35 CLE # zod : [� I T - PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # (DQ) Staff: PARCEL INFORMATION {(� Tax Map and Parcel: e4 5 Existing Zoning P �J Parcel Owner: /W—qAn 4-h6tA l= 1N ry m'V I` Parcel Address: 10p F—[o AA ccoh( City C�i,�r(ot-f�(10 Z State p/IY Zip'22�(S� (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? \ S o A S Address: %D�© Aa 0'1' Ce✓4t( City CtiArloi J i C State �4 . Zip Z2.1ol Office Phone: '( ?>"' ) -l15 2(Q � Cell # qS 3r- l ?A `(124ax #�3�173- 1001 E -mail -)C f006e \4GtI'1DD , Coles. APPLICANT INFORMATION Business Name /Type: 1 Previous Business on this Describe the proposed business, including use, number additional information that you can provide: ,II employees, number of shifts, available parking spaces and any *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 o n or jla9ve the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to he t of my luiowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature — 1 Printed ro (eyis AP�OVAL INFORMATION [H Approved as proposed [ ] Approved with conditions [ ] Denied A�a ckflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 19 physical site inspection has been done for this clearance. Therefore, it is not a detenninatior plin�s wi h h . existallg site plan. $ackfllow Device and /( [ ] This site complies with the site plan as of this date. Current Test Data Nee( Notes: Building Official Date Zoning Official Date G 6 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 mt Intake to complete a following: F-1 YES 0 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES 9 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 ublic water? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Lk YES ❑ NO Is parcel on septic or ublic sewe ❑ YES NO Will you be• , tting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES 4NO Will there be ,n new construction or renovations? If so, obtain the proper Permit. Permit # Zoning Tech to complete the Vi ations: YES ❑ NO If so, List: 00 2M 5 F AUL,4 004- 6a� -a3 ze) at, — 6Q d A ba4gj c�Gi1a ^l7c 00 _ j o 9 d' A- _. i V is c.e0 0 S — t Z ( AbaOA YES ❑ NO If so, 'st: S loch /3 u-,r-� � v Reviewer to complete the following: Square footage of Use: —7 - EYES ❑ NOS � n _, J Permitted as: f Under Section: 0 °�� s�• Supplementary regulations ctin: Parking formula: &ft l �/ll/�' Required spaces: n C 1 ❑ YES ❑ NO Items to be verified in the field: Inspector : Date: Notes: SP's: ❑ YES ZINO If so, List: 5/1/06 Page 3 of 3