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HomeMy WebLinkAboutCLE200700223 Legacy Document 2014-04-25Application for Zoning Clearance pV : \1.fjF. ;N ,.. D/zoning Clearance = $35 OFFICE USE ONLY CLE # A 00 Check # Date: / D' PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: Lai PARCEL INFORMATIONt� J, Tax Map and Parcel: TM 0 1 26© -6()-66-07/M Existing Zoning Parcel Owner: 5 r S (CeL Ua I; P v, ✓i vie d Vintm I S G- L C Parcel Address: d q I ko l k h RwJ City Ch a r 1 D *e:5 WI 16 State VA Zip (include suite or floor) PRIMARY CONTACT C "J Who should we call/write concerning this project. 1 �� LL ✓' JT[;,S,) .11-e State Zip 223 d Address • S �� City�-c r j Office Phone: 34 04-1 Cell # f3S!•99�5-010ax #4.?4C- % %,SCj 24 E -mail htb 0.5i.�.�+ rq r ,� w p • �• co+•� APPLICANT INFORMATION Business Name/Type: D1 s.p,-, (6A ilC-_Vl C Lice zcai- vcl�ro''1 Previous Business on this site (` �Ct ► 1n tQ t• 1 �y Vhn� C@ Ut G CeL5 SVt c y'1 Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any "'R additional information that you can {provide: SCUM e_ u S E: 5 l U S e s�1 �5, 2Zl 'at s 7J12u-5 k . QI 84r �V.w � e.�� !! , *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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Dn� / 3 % Printedi"Cp 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 eompli4nce with the in site plan. Bac1sl'low Device and /or [ ] This site complies with the site plan as of this date. Current Test Data Needed Notes 1 *eSA 977_A Building Official Date Zoning Official Date c�� %��� 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: ❑ YES L N u Is use in LI, III 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 pproval from Health Dept. FAX DATE C% —C7 � (� ❑ 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 ❑ YES ❑ NO Is parcel on septic lic se or ubp wer? ❑ YES L NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES v O Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning Tech to complete the following: r l o oP, P ro,-Y--% oL-A:* c Reviewer to comple a the following: Square footage of Use: �&C YES ❑ O Permitted as: l�� Under Section: Supplementary reg lations section: h 0K Parking formul . Required spaces: ❑ YES O Items to be verified in the field: Inspector: Date: Violations: F-1 YES If so, List: ZINO Proffers: ❑ YES 101NO If so, List: Variance: ❑ YES If so, List: NO SP's: ❑ YES &NO If so, List: 5/1/06 Page 3 of 3 � r Applicaitol ' -fur Zonin, g 0earanc•e t: A� Lk [LYZ'oning Clearance = $35 > : OFFICE USE ONLY CLE # Cheep # Date: PLE.A:St RFV-I)C+ W ALL 3 SHEETS Receipt # _(4)1,�'— Staff; r,J PARCEL INFORMA11ON Tax Map mid Parcel: IM 0 900 -00-66'M67406 Existing, Zoning Parcei.Owner: LJ .5 F ('� u� (1 £? y' , l S� W y��S /_ L.- C Parcel Address, .,� y { k0 f kf h •I mad City 6y it r vi { le State — Zip r (incliide;st>ite or-floor') PRIMARY CONTACT Who should we call/write concerning this project? Address. { D� �rc�r�`� �-�- Ci#yt.�•a r Gl�s�.t!i� State Zip2. J Office Phone- -!1 UY-13 i�� Cell # ai1?7u� � +�`r r J c�p. �. tea►+. APPLICANT INFORMATION �s�,� • � � ' iaeu f � i s / t.�[i 5 � rn Business �Tanxe/Type: _- : 114 le i�ic� �J�afi� l�j •m � C 5" 2f � Previous Business on this site -V 1 •V \q I. uL Va f. • Cd Yn 4 [A U ' Gc�� - Lt l t � �+ Describe the proposed busikess, including use, number pf employees, numWr of shifts, available parking spaces and any a(Ulitional information that you can rovide: 5�15, X41 kz>arS f a>a 7 Se•.e; p a Y, /6 Q � `This Clearance will only be valid on the parcel for which it is approved.. If you change, intensify or move the use to a new location, a now Zoning Clearance will be required. I hereby certify that I own or have the oWn='$ permission to use tlie•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 I understand them, and that I wili'abide by them, Signature Printed ' N—ra APPROVAL INFORMATION [ J Approved as proposed [ `] Approved With conditions Denied j Backflow prevention device. and/or = elrt• .est data neeOd for this site. Contact ACSA, 97?-4511, X119, [ ]'No physical site inspection has been done for ibis ofearA•tice, Thcrcforc, it is not a dcterniinatioxl of co' lnl5hanae with the existing site plan' [ 1 This site complies with the site plan as of this date. Notes- i Building Official Date -Zoning Official Date Other -Official Date ' •County of Albemarle De arti>t' ent of Cori munity Development. 401 Mcb fix a (toad Chariottesvilie,..'VA 22902 'V'oice. (434) 296 -5$32 Fax: (434) 972 -4126 5/1706 Page'2 of i -tin l nni 17 rise 071 T17 cnct, xL I IKOWAn -17Kin A I I Idnmm