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HomeMy WebLinkAboutCLE200700262 Legacy Document 2014-04-28Application for Zoning Clearance - 69®R"11 ea OFFICE USE ONLY onin y Zg Clearance = $35 CLE # z 00 -7 a (,OQ PLEASE REVIEW ALL 3 SHEETS Check # Date: 10 % Receipt # 1e791 & Staff: PARCEL INFORM//��ATIO //N����ryy (� �J Tax Map and Parcel: x,11%60 — C.►(i 0a /'/© Existing Zoning f" , Parcel Owner: Mg Lo -S byIA49, 51n 1. N►L L;J/ir4N WA4T ftlZ' �')2'06"N !s2k p' ParcelAddress:aF3Ob Poo- Au/tc 90 city A%3'/o')ko, /k State ;f Zip=_90/ (include suite or floor) PRIMARY CONTACT (� Who should we call /write concerning this project? Address: J5-("3 ag"'Is' SAP -- kc City /A t-10 '1. kstate 41,A Zip 970/ Office Phone: 6M96$ 0-96 9 Cell # Fax # E -mail APPLICANT INFORMATION a Business Name /Type: 5 JOA":5 Previous Business on this site 1-10'S I f �ZZ Q w Describe the proposed business, including use, nu additional information that you can provide: ;7— of employees, number of shifts, available parking spaces and any *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 /((JVYL*i 16 / / Printed V �1L'V3J '� APPROVAL INFORMATION $ael �y �� and/or Vproved as proposed [ ] Approved with conditions ] d/or IV ackflow prevention device and/or current test data needed for this site. Contact A A�/j7;f4Mt1 Data Needed o physical site inspection has been done for this clearance. Therefore, it is not a de e�ii>ci bp'�1t3f�c$$iyhh�i ing site plan. [ ] This site complies with the site plan as of this date. _ Notes: Building Official Date ls --I_ Zoning Official Date �� 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-,U Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. VYES ❑ 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 I — ? —a 7 YES [I NO Jo1Z 376 Is parcel on private well or ublic water? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ZYES ❑ NO Is parcel on septic o public sewer? ZYES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES ®ENO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 1'ech to complete the ® YES ❑ NO If so, VIVA b b Variance: ❑ YES [� NO If so, List: Reviewer to complete the following: Square footage of Use: DYES ❑ NO r- Permitted as: 1 &4ajP t�4at; —W',A& Under Section: " a I � I Supplementary regulati,¢ns section: Parking formulaa :'�/` Do O Required spaces: A L9 ❑ YES ❑ NO Items to be verified in the field: Inspector : Date: ,, . 1 Proffers: ❑ YES 7— 'NO If so, List: SP's: ❑ YES ENO If so, List: 5/1/06 Page 3 of 3