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HomeMy WebLinkAboutCLE200600285 Legacy Document 2015-02-10<7,p7nn5 -� Application for � °�"`� Zoning Clearance OFFICE USE ONLY c ning Clearance = $35 CLE # ZZ n o f a PLEASE REVIEW ALL 3 SHEETS Check # fVe) ,¢'eP Date: Receipt # /1S�ir� Staff: PARCEL INFORMATION Tax Map and Parcel: �`7 b Oo w Existing Zoning l014) Parcel Owner: evol;o flxrpG/A'f!,;-u Parcel Address: ff`° -f►-� ®/Z City C�lli��i.��d V /l� State Zip include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address: / S_6 ° /�t/r 2^/ city (�t /,J/�.Hrfo /l�j State l/4 zip 20e-'11 �JY Office Phone: cVIY) 9 -2Y'1 Cell # � Y2 "975z' Fax # 99f -YIS� E -mail GA K17 01 71-1 APPLICANT INFO TION Business Name /Type: On e- Previous Business on this site J-,4 tomi e— Describe the proposed business, including use, number of em loyees, number of shifts, available arking spaces and any additional information that you can provide: S/a z �'.S —dam/ *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 ac q yateAg. the best of m �wle e.I have. readjh�ond�ons of approval, and I understand them, and that I will abide by. them. Signature G ✓G;6'/ Printed C✓� /.� APPROVAL INFORMATION [ ] Approved as proposed I [ Vf Approved with conditions [ ] Denied [�,Oackflow 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: 6AAA T1w0 — P_ ��V 1,711 Building Official. Q`_- Date. 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) 972 -4126 511106. Page. 2 of 3. Intake to complete the following: ❑ YES N140 Is use in LI, HI or PD1P zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES ❑ NO 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 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 ❑ YES ❑ NO Is parcel on septic or public sewer? ❑ YESU�4O Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper ❑ YES - ENO Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning Tech to complete the following: Reviewer to complete the following:: ^ n Square footage of Use: YES El NO �. ermitted as: Under Section: z Supplementary regula 'o section: Parking formula: ,,� 0 1 aly\ Required spaces: E]IAEs ❑ NO IteAis to be verified in the field: CA L 1u Inspector : Date: I Notes: Viol ons: ES ❑ NO I so, List: Proffers: ❑ YES ©- N0 If so, List: Variance: ❑ YES �NO If so, List: SP, VYES ' ❑ NO J� �L�ta��� Y �� 5/1/06. Page 3. of 3. p°°l