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HomeMy WebLinkAboutCLE200600303 Legacy Document 2015-02-10Application for Zoning Clearance AL yLFtGiN�' 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 3.3 `a ,fl&f OFFICE USE ONLY 30 Zoning Clearance = $35 CLE # zoo — PLEASE REVIEW ALL 3 SHEETS Check # q79& Date: Receipt # !ri 330; Staff: PARCEL INFORMATION Tax Map and Parcel: 4 (P 1 (-d 0 " 0 3 - d Existing Zoning 6 M , r Parcel Owner: U ✓\0L P- &aJce Cq" 1t° , LL C- ` ► p� Parcel Address: �� � �J Cryrt n'y6)1�°2��11.�City D4WJ g* Ke State V v, Zip Z 2 � (include suite or floor) PRIMARY CONTACT n n Who should we call/write concerning this project? 1-h ETA v Rzi d (434( .7-Y' q 71;,D)"" (`F 3��p 2 I` Address: 2bOrJ (�S�h.- U'�4.Q� City State V ZipZ�D Office Phone: �) Cell# a LF7�FaX# 4_ �Z3 Elm it A Coe ✓►aoleI SD 4�4�e1� APPLICANT INFO AT ON .n (06L 66- C� e C V'\ Business Name /Type: -L4D- "r 3m' 55 Previous Business on this site Describe the proposed business, including use, number of employees, number, of shifts, available parking spa es and any, r. W ...additional information. that. you can provide: .5.`IAL -4— . MS1 f--e. t e V" k-�A� 1M re5 A.Y� -t 17 —1 2 del 43 U -ems. *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 my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signahare • Printed RkrAO( -'L- K G� APPROVAL INFORMATION [ proved as proposed [ ] Approved with conditions [ ] Denied [kJ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119. [ t�'No physical site inspection has been done for this clearance. Therefore, it is no of c a existing site plan. Back low Device and/or [ ] This site complies with the site plan as of this date. Carrent Test Data Needs( Notes Building Official Date o G Date l�O Zoning Official Other Official H� Ggpad 6J 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 3.3 `a ,fl&f r 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`lES ❑ 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 wellll, prov—i e�ealth Department form. Zoning review can not begin until we receive approval from Health Dept. FAXDATE Q —% -S ❑ NO (J` Is parcel on septic or public sewer? ©-,ftS ❑ NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES E-50--/ Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # GoninLy 'Tech to complete the followina: Violations: ❑ YES If so, List: E. NO Variance: YES If so,LV-A ❑ NO M-T-114- Reviewer to complete the following: Square footage of Use: l ° 3 0, [YES ❑ NO � Permitted as: Under Section: Supplementary regulations section: Parking formula: Required spaces: ❑ YES VNO Items to be verified in the field: Inspector : Date: Notes: qrx J3 �ov� (iildit �Q� Proffers: ❑ YES [v] NO If so, List: SP's: ❑ YES M NO If so, List: 5/1/06 Page 3 of 3