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HomeMy WebLinkAboutCLE201400204 Legacy Document 2014-10-30Application for Zoning Clearance s " " "'�- CLE # 2.0 ` 1' OFFICE U$ O,)�iY �© V n 2 I 1 II PLEASE REVIEW ALL 3 SHEETS Check # Date: G Receipt # Staff: PARCEL INFORMATIO �,^ � _/1 ' 0r, Tax Map and Parcel: J� Existing Zoning '1"^^�'Af -A Parcel Owner: Parcel Address: State Zip72Q0 (include suite or floor) r0� PRIMARY CONTACT Who should we call /write this project? �5�\ , Qj t concerning pZ4C)-A- /1 Address: q 00 ( "&err 1 NU-4 City �U- -State Zip zc QJ Office Phone: 6N oq[Q,G(q Cell #gW'ZLt24271Fax# APPLICANT INFORMATION Check any that apply: Change of ownership of use Change of name New business Change Business Name /Type: T- A h) h°, N Y Q � Z2 A I(I / ��4 -A —L C- Q n 1 Previous Business on this site 5,q ►mom, Describe the proposed business including use, number of employf es, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: 4-0 VizzGa. shQ-? c..%n-d 4- ay- e-c;u4A -s , 5 -t0 m�10 Qe 'LSh�1�i- two As�;^,!jh s S. g4 5�ot�C h� ri �n�,►e,(I �H�KK���cn _ *This Clearane will only be valid on the pa el 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 o nor have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurat o e b st of my knowledge. I have read the conditions of approval, and I understand their, and that I will abide by them. Signature Printed 5`10111 -h a P-v)1l ��w�,/.► i lOy APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117. [ ] 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 Date i / Zoning Official GL✓ Date,�6 Other Official �/7 Date`��Z� /Zcj�� County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 DVV1 , Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/N ill 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 Circle the one that applies Is parcel on private well o p�wate If private well, provide Hea orm. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applie Is parcel on septic o u lie sewer? Y 1 Wilj�you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will t ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: 19-74 Y/N / Permitted as: 1i vie Under Section: 22 .1-j Supplementary regulations section: Parking formula: %1 /d .J Required spaces: C Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y/(N) If so,Zist: Prof ers: Y/ If so, ist: Variance: Y /I� If so, List: SP's. Y/ If so, ist: Clearances: SDP's Revised 7/1/2011 Page 3 of CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. I certify that notice of the application, was provided to [County application name and number] [name(s) of the record owners of the parcel] and Parcel Number manner identified below: the owner of record of Tax Map by delivering a copy of the application in the Hand delivering a copy of the application to [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] M Date Mailing a copy of the application to [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date to the following address: [address; written notice mailed to the owner at the last known address of the owner as shown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Sko(L),) yz-A -1D0, Y" R i chi Print Applicant Name 1O122� \14 Date i COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH CERTIFIES THAT Turkind L L C is hereby granted a permit /license to operate a Full Service Restaurant by the .Albemarle County Health Department in accordance with the regulations of the Board of Health , Commonwealth of Virginia. FACILITY NAME: FABIO'S NY PIZZA 111 PHYSICAL ADDRESS: 900 Gardens Boulevard Charlottesville, Virginia 22901 MAILINGADDRESS: 900 Gardens Boulevard #500 Charlottesville, VA 22901 EXPIRATION DATE: December 31, 2015 CONDITIONS- E./ cher Campbell, 11"S, Environm ntal Health Specialist, Senior Please direct questions or concerns to the Albemarle County Health Department, Environmental Health Services, (434) 972 -6219. This Permit Is NOT TRANSFERABLE From One Individual or Location to Another.