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HomeMy WebLinkAboutCLE201400228 Legacy Document 2014-12-04Application for Zoning Clearance CLE# 20H "ZZ ►ti` " "'� x• };:t „r: OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: + Existing Zoning Z? q Parcel Owner: LV,,,zE -r Parcel Address: SP 3 I!* 6-ttL'b Ir b City P , State d7 `ly Zip (include suite or floor) PRIMARY CONTACT L Who should we�caall /write concerning this project!? /� � L r, j �a 1 � Address: ),5 -7 6 (S/ t ad (4 R f ak MValiCity ��V(t�{�� D 19 &w fkstate V � Zip Office Phone: 1f)j) q � -bjt Cell # Fax # E -mail SCO-H. I rj 4 Q-S1 V,SCO1JJ1 /1C' APPLICANT INFORMATION Check any that apply: Change of ownership of use Change of name New business j�Change /� Business Name /Type: rr Sc uls a� �ii'►7gr c o l V y t Previous Business on this site Describe the proposed business including use, number of employ_egs, number of shifts, available parking spaces, number of n vehicles, and an additional informati that you can provide: C AZ)E-CAOy , *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 f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature - Printed Sr —CT 6 APPROVAL INFORMATION $41 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 Date Other Official Date ZL 2 -/Z-6A1 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 A Intake to complete the following: Y /0I Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / (TQ) Will t ere 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 wel r-ptib is w ter? If private well, provide ealth. -D artment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or u lic sewe CYO/ N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # /✓> Y/N Will there 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: Za d 0 01 N % Permitted as:�Del/ Under Section: A,r(!!M • pYP,C'+i C.L Supplementary regulations section: Parking formula: ---f'" Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y / �I If so, List: Proffers: Y / If so, ist: Vari ce: Y /NN If so, List: SP's: O/N If so, List: 67 6 63J Clearances: SDP's Revised 7/1/2011 Page 3 of 3