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HomeMy WebLinkAboutCLE200700190 Legacy Document 2014-01-22do,, � I Application for oning Clearance OFFICE USE ONLY oning Clearance = $35 CLE # PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORMATION ��11 //�� Tax Map and Parcel: � , 0' /� M - 0400 _ Existing Zoning NS-01 Parcel Owner: Parcel Address: IM 3 5�tmc)LE 11 ML City ehAAAITE5yiu State Vh Zip2Z 01 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? WME Uge-Z AN 9. :5e5T16 DE Address: KI (ZC6QZ9'5 A&41; city SiM±( JMS VJUA State & Zioz Office Phone: k Cell #43qq9Jq41 I Fax # t gSb J�tr E -mail APPLICANT INFORMATION Business Name /Type: LAS MAZA Previous Business on this site—_-W (51' 57"P Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any additional information that you can provide: 5AAQrtt !n(.iT 6"R Q�M " 1PNg RE PkIA2Arf�tS *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 ,' knowledg I have read the conditions of approval, and I understand them, and that Iwill abide by them. Signature Printed 3, 7r /E baOM& • V Z—_ 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 l cy� " Zoning Official Other Official Date Date 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 T Intake to complete the following: ❑ YES �Z' NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES, F1 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 ❑ NO �-_..� Is parcel on private well o(I-3- lic 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 o (public sewer? ❑ YES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES ❑ NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonine Tech to complete the following: Reviewer to complete the following: Square footage of Use: 2J4, 1 x us RYES ❑ NO 1 ,� j iP Permitted as: Under Section: '��• Supplementary regulations section: 1., ,1 / �y Parking formula: Required spaces: " ❑ YES NO Items to be verified in the field: Inspector : Notes: Violations: Proffers: VrYES El NO F-1 YES )z NO If so, List: If so, List. Variance: SP's: ❑ YES NO ❑ YES NO If so, List: If so, List: Date: 5/1/06 Page 3 of 3 k+ :rboo�- i'LM fbg- lgle3 CQ l�rr" Sip MI s4J,� relLs Oop-me. 1I s0n (NO �C TRP L, 5M AC ©M66 spa -c. " -i�ple "'� 15�rRooM