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HomeMy WebLinkAboutCLE200600283 Legacy Document 2015-02-10J ' / OY A!. Applicati ®n f ®r vv Zoning Clearance I IlylP OFFICE USE ONLY - O -3 j Rzoning Clearance = $35 CLE # `-z on [„ PLEASE REVIEW ALL 3 SHEETS Check # 7QL4 Date: 1 Receipt # Staff: PARCEL INFORMATION Tag Map and Parcel: 6 -f tv l3 q .- 00--X-00600 Existing Zoning /2 / Parcel Owner: R o (. i l3 �'' e /"\ .lq- h leefV Parcel Address: 2 L�o r w t—t)') l % U -' �rl i� �1 i� State Zip (include suite or floor) 'should we call/write concerning this project? J5�45 (-s L Address: /ig v ��i' 1" y� rags!�;j LNity State VQ� ( Zi pZZ4or Office Phone: ( % r / Cell # BLS . Fax ## � ' E -mail -(°�� •� APPLICANT INFORMATION Business Name/Type: Previous Business on this Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any additional information that you can provide: Lyes..t -r- ", *This Clearance will only be valid on the parcel for which it is approved yMIS ntens4 o move the use tZ n ©1 ©tioif, 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 knowl , . I have rea the conditions of approval, and I understand them, and that I will abide by them. Signature , Printed 1 C( S, `� QL.> LG (Z 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, 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. Notes: Building Official Date i Zoning Official Date Other Official Date County of Albemarle (Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126 511106 Page 2 of 3 W Intake to complete the following: ❑ YES NO Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. ❑ YES ❑'NO If so, give applicant a Certified 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 ®,IQ65. Is parcel on private well or public water? If private well, provide Health Department form. Reviewer to complete khe following: Square footage of Use: 1� YES ❑ NO Permitted as:. -:I _ Under Section: .-A, -.pin (� l fx Supplementary regulalon section: Parking formula: Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE ❑ YES ❑ NO 0-'ES ❑ NO Items to be verified in the Meld: Is parcel on septic �or'public sewer? ❑ YES ©ENO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES D- K Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Soning Tech to complete the following: Vi lations: YES ❑ NO If soy, List: 0 o Variance: ❑ YES E� NO If so, List: Inspector : Date: Notes: Proffers: ❑ YES If so, List: [RNO SP's: ❑ YES If so, List: 01NO 511106 Page 3 of 3