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HomeMy WebLinkAboutCLE200700258 Legacy Document 2014-04-28Application for t4`, Zonin Clearance OFFICE SE , Zoning Clearance = $35 CLE # PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: tJ�� PARCEL INFORMATION QQ Tax Map and Parcel: � NG Q(Ol � 4�' Existing Zoning AID Parcel Owner: Parcel Address: q` -) 616Nwoop STAT1oo /_A) Sri (include suite or floor) 03 7 64Aal- 61155V1UU5 State yil Zip ZZ1701 PRIMARY CONTACT / Who should we call/write concerning this project? A 16vj Address : 126Y A✓WN PSee, 51?5el� City ejAeCo1r-65sv1u.E State yt Zip Office Phone: ( la 1 9 Cell # Fax # Z3�5 E -mail f'IICD�¢ o uivlka �25 L63 L�- TION � Business APPLICANT Name/Typ FORMA flw2rd 15 Ey ,i✓D4l67.0,4Z 5 cc ?l. ants Previou'sBusiness on this site AAA i9J &A 0 aA46 �6QiLr Wicribe'the proposed business, including use, number of employees, number of shifts, available parking spaces andany additional information that you can provide: QLe w eCL Ce h$k•/ 4 5ewi 4v 4& (h1,US&Aj /actnd✓y .f , J. . cu:LA.._ -0 . _ - -/—._ it ?i_ -1... . ...... ...... ...._.- -- . . . _ .. *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 m owledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed N/eD6e P. - AAJ,,nSNK,e— AP`jrROVAL INFORMATION [ proved as proposed [ ] Approved with conditions [ ] Denied ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119. [V]'flo 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 Date......1� - Zoning Official ; l::. . • Date Other'Ot iciaf, Date UOUnly OI Alpemarle juepartmeni oI t- omintu nLy "rVC1UPU1VI1L 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fag: (434) 972 -4126 5/1/06 Page 2 of 3 Intake to complete the following: ❑ YES [9"! O 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 ❑ NO Is parcel on private well orLublic water? If private well, provide Health rep- Mrient form. Reviewer to complete the following: Square footage of Use: '31-79 �YES ❑ O ( n Permitted as: h6 Under Section: Supplementary reddlations section: Parking formula: 6 AZFa Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE (, i ❑ YES ❑ NO ❑ YES ❑ NO Is parcel on septic or public sewer? ❑ YES 2/NO �^ Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES [D/NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Items to be verified in the field: Inspector : Date: Notes: Gorilri -i'ecn to pompiete the tonowin : Violations: Pro fers: ❑ YES F1 NO YES ❑ NO If so, List: If so, List: Variance: SP' : ❑ YES NO YES ❑ NO If so, List: If so, List: 5/1/06 Page 3 of 3