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Home My WebLink AboutCLE200700303 Legacy Document 2014-05-16Application for Zoning Clearance J�± lAih OFFICE USE ONLY ❑ Zoning Clearance = $35 CLE # 676 PLEASE REVIEW ALL 3 SHEETS Check # Date: O Receipt # 66 � Staff: V-15 PARCEL INFORMATION �+ Tax Map and Parcel: 6Yd " GCS r 06 -d l 1 06 Existing Zoning Parcel Owner: Parcel Address: J'-99� �r_khts 'ate �[Lnf✓lii�'e. City Grazet State VA Zip Z�932 (include suite or fl or) PRIMARY CONTACT i ( Who should we call /write concerning this project? �_ /t i' l S SL ,\ /� nn Address : Z S—% 3 o .�� C, n A t` City S- Q%J %-A_5, State V Zip Office Phone: Cell # _79 ' ©q Fax # E -mail APPLICANT INFORMATION / �� Business Name/Type: 6rown5ville. ldal ket 1 eOA &_ VeM1e4 25&yle Mcl 96-S 56711csn Previous Business on this Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any additional information that you can provide: -DA a —A ce- -to i-e. qs oie i Q +'h G> I 'a,.v c -e-S A mr- L'o's, o r .3 r- *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 he best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed rQ V-r © 1) IQ % AA 1 APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backt1ow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119. [ ] No physical site inspection 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 � Y.1 Date i ?-� ( -L ('0-1 Zoning Official Date F=Ao1 '7 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 _N�NO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES NO Will there Xefo d 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 Cub li�water? If private well, provide Hea ent form. - Zoning review can not begin until we receive approval from Health Dept. FAX DATE ,�E*ES ❑ NO Is parcel o sep'ti or public sewer? ❑ YES -�KINO Will you be` putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES X91 O Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # LonmLy 'Tech to complete the followin Violations: YES ❑ NO If so, List: Variance: ❑ YES ,0 NO If so, List: Reviewer to complete the following: Square footage of Use: 3500 Con1V PN'�c,e YES ❑ NO Permitted as: L f Under Section: C--7 Supplementary regulations section: Parking formula: Required spaces: ❑ YES ❑ NO Items to be verified in the field: Inspector : Notes: Date: Proffers: ❑ YES � NO If so, List. SP's: ❑ YES NO If so, List. 511106 Page 3 of 3