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Home My WebLink AboutCLE200700252 Legacy Document 2014-04-28Application for r- Zoning Clearance` OFFICE USE ONLY % e, oning Clearance = $35 CLE # PLEASE REVIEW ALL 3 SHEETS Check # 0 S h Date: 100-07 Receipt # (' „`77/ / Staff: be PARCEL INFORMATION Tax Map and Parcel: 0'7600-66 00 01 Q' Existing Zoning Parcel Owner: CA V (, �('r(/�� (Jl /G �© �i� / C✓ �Df / O Parcel Address: J �a� �� City O,h, V Ii l State Zil) (include suite or floor) PRIMARY CONTACT{� t Who should we call /write concerning this project? !"J ep A ne Address :2 City IPA /)I, Wja State //4 Zip22 Office Phone: V _ Cell #Wll42r -�Y*ax # E -mail APPLICANT INFORMATION �/�__ Business Name /Type: E� ryl dj TJ�• �` rto Previous Business on this Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any additional in rmation that you can, provide: ( '.� 5 Lt Y i Z ` Of/ 't *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 accur to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signat Printed t h A-yt 11 YiV_j goOVAL INFORMATION rved as proposed Approved with conditions O ��+ Aakflow prevention device and/or current test data needed for this site. Contact ACSA, 971 -451 ” 1) "''ce an pp � 9 G7114S1' physical site inspection has been done for this clearance. Therefore, it is not a determination �I ceded site plan. _ A 977-4511, 119 [ ] Thi ite co plies with the ' e 1 i as of this date. Notes: r t Building Official Date (of t S l Q-1 Zoning Official Date 101 1 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 a following: F-1 YES O Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. [KYES ❑ NO *ill there be food preparatio If so, give applicant a Health ep ent form. Zoning review can not b in ntil we receive approval from Health Dept. FAX DATE 0 t p ❑ YES ❑ NO Is parcel on private well or z blic __ at�x? w_ 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 E� O 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 # Zoning Tech to complete the following: Violations: F] YES NO If so, List: Variance: ❑ YES Rj'NO If so, List: Reviewer to complete the Square footage of Use: YES ❑ no Permitted as: Under Section: 0 _1e a3 • Q , Supplementary reg(ilations section: Parking formula: VV 0i Required spaces: ❑ YES ❑ NO I Items to be verified in the field: Pers: M YES ❑ NO If so List: a000 -4 SP's: ❑ YES 0 NO If so, List: 5/1/06 Page 3 of 3