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HomeMy WebLinkAboutCLE200600247 Legacy Document 2014-12-02Application for Zoning Clearance 0 Al„ County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 / _q � n �Z 5/1/06 Page 2 of 3 � OFFICE USE ONLY `7� '� 3 Zoning Clearance = $35 CLE # " 2_ oeD(O c PLEASE REVIEW ALL 3 SHEETS Check # , j' / ) S Date: /a.-9-0-617 Receipt # (n 2,1 Q / Staff: PARCEL INFORMATION TIION 7� Tax Map and Parcel: �D ®o eo D /� 316 a Existing Zoning /" DH C-- 70� Parcel Owner: Pj 1 LC �v75 Pe4e, tiger --6,i (awk- � r' i p Z��(� Parcel Address: St4 i 4 e t- 00 City ��1 @ ✓16 4 SV I I Ie-State V Zi (include suite or floor) PRIMARY CONTACT 60 Who should we call /write concerning this project? 05 Pe ev- Je•Ffer-son T:kw� Address: 6tti',+e, L '00 City GkM aff esi6 t k State VA Zip 2°11 Office Phone: (U$ q S 2 - 77&ell # Fax # L182' #6182'7351 E -mail &I t I sr"i 4- � ". �A- L'IYCq APPLICANT INFORMATION I I , ( VXDCVVV,- i un Jt lS �elW► -S Business Name /Type: i�l'1 CA ffiA ll 6ers©n t-rOSP A4 J Previous Business on this site Describe the proposed business, including use, number of employees, number of shifts, available parkin spaces a�}d any =V additional information that you can provide: *of MA-� t? h ��it� FC'/ytng SUodor *- 5 ao mu f r�c� l� erne 12le r�ark�nc�, *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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed 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, x119. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a detennination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official �— Date i k b Date q Zoning Official -D Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 / _q � n �Z 5/1/06 Page 2 of 3 � S qJ Intake to complete the following: F 0-0 %a q-z 1 4 iv io C? ❑ YES LJ'Nv Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES R1,K0 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 /ubl� Is parcel on private well o pr' is water? If private well, provide Health - Depart ent form. Zoning review can not begin until we receive approval from Health Dept. AX DATE YES ❑ NO Is parcel on septic or blic sew r? ❑ YES 2--NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit. # 52"YES eNO Will there be any new construction or renovations? If so, obtain the proper Pen-nit. Permit# ZtOC�U 500 AQ-\\ Zoning Tech to complete the following: Reviewer'to complete the following: Square footage of Use: 6 [/YES ❑ NO Penmitted as: o1WY e - Under Section: 2�) . Z Supplementary regulations section: ParI ng— r}} lle 112 67 � 53 ('13:53 �J Required spaces: TS ❑ YES ❑ NO Items to be verified in the field: Inspector : Date: Notes: Violations: ❑ YES !/ NO If so, List: Pro fers: RZ YES ❑ NO If so , t: (lv Variance: El YES NO If so, List: SP's: ❑ YES 21NNO If so, List: 5/1/06 Page 3 of 3