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HomeMy WebLinkAboutCLE200700282 Legacy Document 2014-04-28Applicati ®n f ®r Zoning Clearance .� Cli AfJIF"'fi J'� k 'AJi� ' �IYKiIh�P ] Zoning Clearance = $35 OFFICE USE ONLY CLE # _ Voe,-r DU :29a PLEASE REVIEW ALL 3 SHEETS Check # 66 l o l Date: l7- � Receipt # Staff: V $ PARCEL INFORMATIION �� Tax Map Parcel: n-- �7 6 I -IT and Existing Zoning Parcel Owner: Parcel Address: ,661.v l�i?j (n I%�i,� Ltt� City �11�iP�(�i QSVi �.�Q State � A ZiPjjqM (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project?_ mgt(! Address: p() fbr>L TALI City m)'Qr State Q Zip L � i�/ Office Phone: Z( 1'1) �� �.I [ 1 Cell # Fax #1-,7 ,7 16 '7d1 E -mail �Wffijee(? APPLICANT INFORMATION Business Name/Type: Previous Business on this si TZ4 ,f/Afl, C 6 L U Describe the proposed business, including use, number o employees, number of shifts, available parking spaces and any additional information that you can provide: b l7 41✓m 's 'A �u_:)MlA!E:A > *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 1 own or have the owner's pennission 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 1 understand them, and that I will abide by them. Signature �,l,M �% 7l vC�J-t� Printed �%ivGl� fv e(, f pNd APPROVAL INFORMATION [ ] Approved as proposed [/Approved with conditions [ ] Denied [ �,Oackflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119. [No site inspection has been done for this clearance. Therefore, it is determination physical not a of compliance with-the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official �— Date /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 5/1/06 Page 2 of 3 'WM .I . Intake to complete the following: P'YES ❑ NO use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES U 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 1 Is parcel on private we I or public water? If private well - ro ' e Health Department form. Zoning revie� can not begin until we regeive approval from Iea1 h Dept. FAX I ATE ❑ YES [ep Is parcel on septi or pu - ew r. ❑ YES ,ENO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES . i NO Will there be Many new construction or renovations? If so, obtain the roper Permit. Permit # Lomn,-I j ecn to complete the following: 'YES ❑ NO If so, L A„ n Variance: ❑ YES r❑%NO If so, List: Reviewer to complete the following: SGuarp footage of Use: 42 © YES ❑ NO � Permitted as: l.(,U•tjkw ti Under Section: Q 7 • e 3 Supplementary gulations section: )a Parking fgrr�y]�� Required [i/ YES ❑ NO - - - - - -- Items to be verified i the field: S a�i4i ba Inspector Date: Notes: Proffers: ❑ YES P i /NO If so, List: v SP's: ❑ YES P"NO If so, List: 511106 Page 3 of 3