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HomeMy WebLinkAboutCLE200700260 Legacy Document 2014-04-28Application for Zoning Clearance iii � : Y� � in OFFICE USE ONLY Doing Clearance = $3.5 CLE # t 6 © -7 0 PLEASE REVIEW ALL 3 SHEETS Check # Date: d D 49`0 7 Receipt # b1W 3 Staff: W A PARCEL INFORMATION Tax Map and Parcel: 0-7 6MI —06-66 — 00'-/ A Q Existing Zoning �--- -� Parcel Owner: ,I \y r->u) C]rO— /70 r l &S I—Z_C___, r Parcel Address: P-1 City C " e �C (� State _� 'nclude suite or floor) "C -(mil W PRIMARY CONTACT G L Who shoul a call /write concerning this project? Address: 3 City6� V1 t k ° '! ,q 3j 22.l 114V Office Phone: Cell # Fax # APPLICANT INFORMATION ,Business Name /Type: State E -mail V Zip Z9 O 4,6 6v] Zip zz� It -/kox( _�-lG ObN_ I Previous Business on this site vgzzzlw - 0"- pz LoyyA4 ,QL-VA` � itQ Describe the proposed business, including use, num er of mployees, number of hifts, avai a pa I �t >> additigqnal information that you can provide: �'�� �GyL� +% !{ 21 h19) d r S� LQ '20 4 r' S S _rn s A z i►1 -t/►S 2rs vIS.-F *This Clearance w ll ily e v id � th parcel f- which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will b re uired. I hereby certify h t I own r I ve ie wner's nnission to use the space indicated on this application. I also certify that the information provided is true and acc r e to the a of y nowle �e I have read the conditions of approval, and I understand them, and that I will abide by them. Signature / Printed � � .U__ UL ---V�� APPRO AL INFO TION �� �' d �� [ ] Appra ed as propos [ ] Approved with conditions [ ] Denied [ ]Back ow prevention evice and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 19. [ ] No p ysical site insp ction 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 I'D l2 q Zoning Official Date D t 10 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 ss � � I .-Fo �a r, 8' K'V\°12,1- 1012-81 0* ' "i 0 Intake to complete the following: DIKES I ❑ NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES . X10 ' 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 CJ—V6— 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 E�1<0 Is parcel on septic or public sewer? ❑ YES E4—X15' Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES 0 Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Goning 1 ecn to complete the Ionowing: Violations: ❑ YES If so, List: VNO Variance: El YES If so, List: NO Reviewer to complete the following: L� 'OeI Square footage of Use: 6A- A-Of O, n 61/ 10/YES ❑ .7,T@ V Permitted as: V� Under Section: %1 lImil t)YG�I CM Supplement arx reAtions section: Parking formula: Required sp cesl� „�. d"�"` W�—'r., ❑ YES ❑ NO Items to be verified in the field: Inspector : Date: Notes: SE, s:. YES ❑ NO Ifs ,List: 5/1/06 Page 3 of 3