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HomeMy WebLinkAboutCLE200600221 Legacy Document 2014-10-03Application for Zoning Clearance OF A �Q fc5i , 3�'G m OFFICE USE ONLY / Zoning Clearance = $35 CLE # 'Z OO& Z 1z PLEASE REVIEW ALL 3 SHEETS Check # /63 5 Date: Receipt # Co I g % 7 Staff: _ PARCEL INFORMATION / Tax Map and Parcel: • 0 Ei,5 t✓ O - 0 Z 06 00 q a U Existing Zoning V Parcel Owner: L A 1 ( c- a L_ .'1`I pr;:5-i jq o, gjS I - t c_ Woo lii>--acoK,7 C Parcel Address: [L-' � e - SQA I aNL� City CA kp Lc>- Cf Vi,tcState Vb ���/t Zip�� -`�o (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? �`� y,1 65 Hbwwo Address : If �. R V l �� 14J CityC AN L0114: -;) -' LL- Late VI�G L rAk_ Office Phone: ` ���� °Cell #l- 3�,� Fax # �-°f ;.", [� E-mail %j c� �tJlt'� (s U %!`� t urC�. C3 APPLICANT INFORMN Business Name/Type: U, J L L_ c_ Previous Business on this site E L.l VC `(E L_6e 2i L &L6,P,0 t y/f Describe the proposed business, including use, number of employees, number of shifts, available arking spaces and any additional information that you c provide: �j G�t.L% Of G"% � N\-. L tU S [ C �� (,/?��'1/� '� eAlu, A- 1-1 v` %A 1--i 1_I- V) AL f XL7 Ar _C -A f C-- —1 10 A. /V, • r ,> /° n a.., C e, q_ of Ass t J :an It U W rr 1 ts:.i_l, _ i'�JJ i jrj (__ Y 0 1`Z t;-- -It I. -( 7% c1/l ��� e .�^ kb At i -Gj'7` *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 t t I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided T is true and ac to to the best of my know edge. I av read the conditi so f approval, and I understand them, and that I will abide by them. Signature , --�i�. II a �. ?rmted APPROVAL INFORMATION [�pproved as proposed [ ] Approved with conditions [ ] Denied [�ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119. Io 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 Date cil 1410t. Zoning Official Date L Other Official Date k:ounry oz Alnemarie >vepartment 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 [�4 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 N Is parcel on private well r public wi ? If private well, provide ealth D en*eval Zoning review can not begin until we rece from Health Dept. FAX DATE RYES ❑ NO,� Is parcel on septic o ublic sewer9 ❑ YES [;� NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES 0 NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Coning Tech to com Violations: ❑ YES LNO If so, List: Variance: ❑ YES [PINO If so, List: the Reviewer to complete the following: Square footage of Use: _- 0 19/YES ❑ NO �� Permitted as: _ CIAP — 0,00 i a ' 4ib1&+-ramZ,( J Under Section: _ , a,) lJ 1 .2 "�•; - l A(9 ) Supplementary regu ,t ns section:. Parking formula: Required spaces: D��rvDIU ❑ YES ❑ NO 11 l Items to be verified in the field: Inspector : Date: Notes: Ak Pjn© —44q 511106 Page 3 of 3 Proffers: ❑ YES If so, List: [NO SP's: ❑ YES If so, List: WNO 511106 Page 3 of 3