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HomeMy WebLinkAboutCLE201200003 Legacy Document 2012-02-0150. 00 P)u M (/),I Y I Application for Zoning Clearance CLE # Z b 17 - 3 PLEASE REVIEW ALL 3 SHEETS OFFICE i1 � O LY Check # pate., Receipt #W Staff: �rylAn r_, PARCEL INFORIVIATION 5 d0 , �d d�'l6&Ifd Tax Map and Parcel: Existing zoning Parcel Owner: �L& - Parcel Address: 0\2' aq=b� 0l \ \_67 c � _ Cit �c ,oy �\ State \P A- Z9p2�1�� (include suite or floor) PRIMARY CONTACT p Who /write L L� should we cal] concerning this project?�v` i Address: City State Zip Office Phone: (�n92 it,}�t( Cell # Fn `- #� -� [ E -mail APPLICANT INFORMATION Check Any that apply: =change of ownership Change of use Change of name New business Business Name/Type : "MV�, a� Z g' Previous Business on this site \ �'� (A` _ -Describe the proposed business including use, number of employees, number of shifts, available parldng spaces, number of vehicles, and any additional Information that you can provide: *This Clearance will only be valid on the parcel for which it Is approved, If you change, intensify or move the use to anew 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 th��,,_?.i<oe -my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature K c "�`%- `� Printed A,���`��.� APPROVAL INFORMATION Approved as proposed [ J Approved with conditions [ 'j Denied j Bacicflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xi 17. [']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 It Zoning Officia) . i Date Other Official -- !` � ate l A ,�.0 2-! County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voices (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 Intake to complete the following: Y N Is W in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. V Y/N ill 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 p blic water If private well, provide Health epa en orm. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies___ -- Is parcel on septic or ub1ic sewer 0!-��ube putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / Wil ' e 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: GGIA � j c O Q` ((�� 6 (,11/UC',✓, f I j N 'P'ermitted as: k11111 ¢ ` Under Section: -Z L), Z, ) Supplementary regulations section: Parking formula: f j dO J Required spaces: Y/ Items to be verified in the field: Inspector: Notes: Date: Violations: Y/ (�D If so, List: Proffers: Y /i') If so,rist: Varia ce: Y / If so, List: SP's:. Y / If so, ist: Clearances: SDP's Revised 7/1/2011 Page 3 of 3