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HomeMy WebLinkAboutCLE200600222 Legacy Document 2014-10-03Application for Zoning Clearance �ypF AL Zoning Clearance = $35 OFFICE USE ONLY CLE # -z-0 0 t0 - Z -z PLEASE REVIEW ALL 3 SHEETS Check # _ Date: Receipt # 101 9, % 9 Staff: PARCEL INFORMATION / �J�° �' ® C., ✓ Tax Map and Parcel: d Existing Zoning r �� Parcel Owner: i J Parcel Address: 1 �� ,�CN{)7'(oC,��(2 Citf3ALQL2tiCC -J\Ac.c<:�- State VtVCGI,Iht,A,- Zip a (include suite or floor) PRIMARY CONTACT y _ Who shoul d we call /write concerning this project? I— h`,LJ1zn4 -C6- Address :4fl$ C . 'RQ UR Cit L 'C(�Sl% ��State �f�,(� -C� I,• - [ Of ' ZipJ Y02— Office Phone: 3 � APPLICANT INFORMATION BusinessName/Type: rO' Akk S ELK 0� $ ReALff- J- LLr- Previous Business on this site Describe the proposed business, including use, number of employees, number of shifts, avai ble parking spaces and.,any additiona inforation that you can provide: ��L t p�iw� ZN e S 6,r�tC� G 1��� upui's �.�u�l' m %1.6�C G S Pi�Gt° S '--- 'M � C�2dtth.�1''L'i �L� ✓`'c 1,0 L�•7�C S *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify ormove 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 cc to to the best of my k le e. I have read t conditions of approval, and I understand them, and that I will abide by them. Signature Q Printed W i2 r✓ GL% ©�yl>, 20 AOROVAL INFORMATION [ 11 Approved as proposed [ ] Approved with conditions [ ] Denied [ j�Backflow prevention device and /or current test data needed for this site. Contact'ACSA, 977 -4511, x119. [ o physical site inspection has been done for this clearance. Therefore, it is a.determination of V] not, compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date L-)V) c y o 6 Zoning Official Date !A14" 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 , &y i 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 ® 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 o public water. If private well, provide He a nt form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ❑ YES ❑ NO Is parcel on septic o ubhc sewer. ❑ YES [$a NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES [K NO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 1'ech to complete the Violations: ❑ YES ❑ NO If so, List: Variance: ❑ YES ❑ NO If so, List: Reviewer to complete tthefollowing: 6 4 Square footage of Use: (O i YES . ❑ NO -I Permitted as: Under Section: %i � • I - C 1 4 Supplementary regulations section:. tid a Parking formu a: %� , l . Required space O G L1 YE ❑ N O it U hhyu� (1 �cQd�yl Items to be verified in the field: Inspector • Date: Notes: Proffers: ❑ YES ❑ NO If so, List: SP's: ❑ YES n NO If so, List: 511106 Page 3 of 3