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HomeMy WebLinkAboutCLE200700272 Legacy Document 2014-04-28Application for Zoning Clearance OFFICE USE ONLY /ry ❑ Zoning Clearance = $35 CLE # o�GcS %,�JDc�7� PLEASE REVIEW ALL 3 SHEETS Cheek ff�. Receipt* Staff: ILTs PARCEL INFORMATION of I. Tax Map and Parcel: - _05,;" oo -oo Existing Zoning Parcel Owner: I-4al I u A&o& A W..' P -,1764 1(gaJ- A 6iba), GG L'. Parcel Address: "�. °� Um'K' KS' City C� ��(,A\(j \i&State V Zip (include suite or floor) PRIM -ARY CONTACT Who should we call/write concerning this project ?l?� Address: �� P�� City State Office Phone: (ice %g Cell # Fax # 33 E -mail )(�o APPLICANT INFORMATIO Business Name /Type: ffic, Previous Business on this siteQl.��� Describe the proposed business, including use, number of employees, number of shifts, available parking space and any additional information that you can provide: �1v��Q�f Cam. Cpl ��� Qi' <� � L��0NgS' n, *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 n r ave th ow}i''s p rrnission to use the space indicated on this application. I also certify that the information provided is true and accurate t th, t} st of m kn wed lave read the conditions of app ;oval, and I understand them, and that I will abide by them. Signature Printed K&K t4o"�_ APPROVALINFORMATION [A Approved as proposed [ ] Approved with conditions Dm4ed Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 5 , 4flil ow Device an [ o physical site inspection has been done for this clearance. Therefore, it is not a deteiminat n l�lia'ta hie s h site plan. t"t�ntactACSA 977 -4511,,1119 [ ] This site complies with the site plan as of this date. Building Official Zoning Official Other Official Date 11 Date Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of 3 0 Intake to complete the following: ❑ YES © /NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's R;;:N�(C-R) rt packet. ❑ YES O 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 or blic wa er? If private well, provide He rtment form. Zoning review can not be in until we receive approval from Health Dept. FAX DATE ❑ YES ❑ NO Is parcel on septic or p lic se er? Ej/YES K Will you e putting up anew sign of any kind? If so, obtain proper Sign pe t. Permit # ❑ YES ZNO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning "Tech to complete the Violations: ❑ YES 2'NO If so, List: Variance: ❑ YES V1 NO If so, List: Reviewer to complete the following: Square footage of Use: [`YES ❑ NO . Permitted as: {�P Under Section: ; ,a'- 10 J 244- 1 Supplementary e ulations section: Parking formulA — C Required spac s: ❑ YES NO Items to be verified ine field: Inspector : Date: Notes aCX7!� ?3 VSo'y,,1L rs: ES ❑ NO istO.`� SP's-/ FNES ❑ NO o M 1 511106 Page 3 of 3