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HomeMy WebLinkAboutCLE200600240 Legacy Document 2014-12-02Application for'��h ` Zoning Clearance., OFFICE USE Y [ Zoning Clearance = $35 CLE # © ©� PLEASE REVIEW ALL 3 SHEETS Check # 2 5 S 0 Date: -5 —O Receipt # fe,2,J 5 (5 Staff: PARCEL INFORMATION Tag Map and Parcel: o5 o J / Q ,:2 — d 1— 0 0 J Existing Zoning Parcel Owner: Parcel City CR3Ze�+ State V 7t Zip (include suite or floor) SU� �e 0 7 PRIMARY CONTACT Who should we call/write concerning this project? h+ c� �q Address :go rTUdU M(AA l�iq) iV City State �� Zip o`d /a Office Phone: ff 3) � l Il Cell # I2•G Fax # K 3 'i - 3 b 1 ` E-mail N (5 0K'P APPLICANT INFORMATION BusinessName/Type: ('dP X�1�z- R �y Previous Business on this site Jer Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and � additional information that you can provide: O �a+' eot+ 0 c ,r 4�f=qe y 4 4771 t' *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 m knowledge. I have read the conditions of approval,, and I understand them,, and heat I will abide by them. Signature 6 " Printed fi 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 determination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. F�� Not +-�— AM, ct Building Official �- Date 1 Zoning Official Date 1'b o l0 Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of 3 Co M 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. Q ,,,, ❑ YES DINO � J� �e -u Will there be food preparation? If so, give applicant a Health Dep Zoning review can not begin until we Dept. FAX DATE 10—,5-04 Reviewer to complete the following: Square footage of Use: [✓'YES ❑ NO � `p Permitted as: Under Section: artment fo receiv r l Health Supplementary regulations section: ❑ YES ❑ NO Parking formula' d Is parcel on private well o li c water? 1 42b 6 � a �,° If private well, provide H p ent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE YES ❑ NO Is parcel on septic or ublic sewer? [YES ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES ❑ NO� / Will there be any new constructYdn or reno�/ations? L �6,� If so, obtain the proper Permit. Permit# A 60S �a,odr�aeg,ac. Zonine Tech to complete the following: Req fired spaces: — �s 1)5JTMwv S-v-fe.(�QN -� ❑ YES ❑ NO Items to be verified in the field: Inspector : Notes: Date: Violations: ❑ YES ❑ NO If so, List: Proffers: ❑ YES NO If so, List: Variance: ❑ YES ❑ NO If so, List: SP's: ❑ YES ❑ NO If so, List: 5/1/06 Page 3 of 3