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HomeMy WebLinkAboutCLE200700160 Legacy Document 2014-01-22Application for "t "�' i� 1. Y Zoning Clearance" a" 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 7� i'f-, ",/ OFFICE USE ONLY CLE # Zoning Clearance = $35 Check # [n 1$2 Date: _D PLEASE REVIEW ALL 3 SHEETS Receipt # &X9013 Staff: -1 PARCEL INFORMATION OG /0) /� y - " 0© -/3 2,0o Existing Zoning / !✓�� Tax Map and Parcel: t U as drQ & - / e-3 Parcel Owner: / /' ��! % l/ ! Cs 121D D /e- ° l Parcel Address: / "G(ity / State Zip (include suite or floor) PRIMARY CONTACT , �" ` a ' Who should we call /write concerning this project? I1 u e' ':E-9 ' X �` ! a t City (', �'�C� e!� Il✓/C� 'v�IWie`( l))'y- Zip Address: 2); Office Phone: (_��? . -Cell Z/V 03 Fax # A&-Z111 _E-mail t� Lee Ct'l -t. c✓ �a t �'G�. APPLICANT INFORMATION r Business Name /Type: 7r3 71 Q �Y C Previous Business on this site Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any /- 2- -/-Y- A additional information that you can provide: VIl�2/i � 2 *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 luiowledge. I have read the conditions of approval, and I understand them, and that I w'llpabide by them. Signature G. Printed APPR AL 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 witl the site plan as of this date. Notes: gVP li OP K di- It U4AI.. t4 �✓LN�� Building Official Date Zoning Official Date 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 7� i'f-, ",/ Intake to complete the following: ❑ YES 2 NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES NO 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 E 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 ['YES ❑ 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 # ❑ YES LJ NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Coning 'I'ech to complete the following: Violations: ❑ YES ❑ NO If so, List: Variance: ❑ YES ❑ NO If so, List: Reviewer to complete the following: Square footage of Use: ❑ YES ❑ NO Permitted as: Under Section: Supplementary regulations section: Parking formula: Required spaces: ❑ YES ❑ NO Items to be verified in the field: Inspector : Date: Notes: 511106 Page 3 of 3