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HomeMy WebLinkAboutCLE200700273 Legacy Document 2014-04-28°C /}-x Application for Zoning Clearance 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 OFFICE USE ONLY ❑ Zoning Clearance = $35 CLE # t) b 0? 25 PLEASE REVIEW ALL 3 SHEETS Check # Date: j %- Receipt # �� d (') Staff: o—jf PARCEL INFORMATION Tax Map and Parcel: ( S�S�(� 0 " 0 D'— © Existing Zoning ( — �, ( ®�yi�rt�•�C) Parcel Owner: r( 6,R,00 14s- C)CIA zc __/z C _/e1/-'11 Parcel Address: 1209 City ZipZ2 �D� ? JV: A V /" k� /t r� ") (include suite orlloor) V e y�ollc � Q e � /C �-L ✓ �jC �c7u�Q. eF3r� RIMARY CONTACT /C? b�Vc� o- sheuld -rv� :�,v;n concerning this prof t? ✓; G✓v75 ✓t C �'SS f'—' .� Cress: X G % �- (�Ji��X�.�oc)� twice C/City a�lv 4 le tate /✓,/r/ Zip�ZS'a/ _ Office • r ._!Pe-222 7 Cell # Fax # E -mail APPLICANT INFORMATION— .-- ,✓/ Business Name/Type: ea i ,4 S pr Previous Business on this site 1A r Lv Describe the proposed business, including use, number of employees , number of hif s, ava' able pa to 's Ices nd any addition ,aal inform tion th y u can provide: _ �' /`C'tr2 — i l.E��� *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 accurat tip the best of my knowledge. I ha d -•the conditions of approval, and I understand them, and that I will abide by them. ifi(o f /�S.�9�1� Signature _ Printed r✓�/�rl /V'.c4 AP-PR AL INFORMATION — - - [!� /Approved as proposed [ ] Approved with conditions BadUmipcDeviee and /or [!�] ackflow prevention device and/or current test data needed for this site. Contact ACSA, 97 -4tiek i t Test Data Needed No physical site inspection has been done for this clearance. Therefore, it is not a detertnina 'o 8 t p ip Av j, 1714!5 Tjls�tjg 19 site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date G10:1 IL Zoning Official Date { l 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 [NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES M"'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 or If private well, provide Heaartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑ YES ❑ NO Is parcel on septic or ublic se er? ❑ YES EjAO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES dNO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # GoninL 'Tech to complete the following: Violations: / ❑ YES ❑ /O If so, List: v Variance: ❑ YES Q NO If so, List: Reviewer to complete the following: Square footage of Use: EY ❑ N Permitted as: W-(TLy Under Section: •(t• 1 b Supplementary regula ions section: Parking formula: 11;�)0 Required spaces: ❑ YES ❑ NO Items to be verified in the field: SP's: El YES .❑i'NO If so, List: 511106 Page 3 of 3