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HomeMy WebLinkAboutCLE201400234 Legacy Document 2015-01-09-A-ppiicati ®n for Z nin Clearance Ul' dLU/l�ri CLE #� OFFICE U R ONLY 2 I"t PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORMATION L ( ) Existing Zoning Tax Map and Parcel: I `J _1J 5��1 &�' Parcel Owner: Parcel Address:s'�� f:1VOM "d\ ` V'\Ial 6ty�iVi4�1� 1� �� 1 \��tate � Zip22°� 0� (include suite or floor) PRIMARY CONTACT i �VeA Who should we call /write concerning this project? Address Zob\o C,oV�VtiN� �i \�\o AXIeCity tYi AV MVc A e State Zip��c �1b Office Phone: �G✓IA' �Sk-(D Cell # i,Sl: �20'S t #>25 S 'f\—� mail p{ 1 C.2 �P 0 W APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business O D Business Name /Type; ��S Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of 6\k 1M vehicles, and any additional information that you can provide: fe SMA *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 tiie 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 � A� Printed t—�`� S� 'M US \rytAA APP OVAL 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_ Zoning Official 4A 41 Date (� Other Official Date County of Albemarle Department or Community LeveloplaC11 L 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 1,0 \ :r a Intake to complete the following: Y i Is use LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /9) 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 Circle the one that applies Is parcel on private well or public water? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE_ Reviewer to complete the following: Square footage of Use: ermitted as: �*R1 Under Section: Supplementary regulations section: Parking formula: Required spaces: Y/N Circle the one that applies Items to be verified in the field: Is parcel on septic or public sewer? Y/© Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Inspector : DAte: Permit # ' Y I(N Notes: Wil ere be any new construction or renovations? If so, obtain the proper Permit. Permit # r7 - - ---- _ ----I —j.— 1.L r ii ...e..,.. Aj Vlllll LV VV1aa 1vYV �. Viola ns: Y/ If so, List: Proffers: /N f so, List: Varia ce: If Y s/ o, ist: SP's: Y idI If so, List: y� / Clearances: SDP's Revised 7/1/2011 Page 3 of 3