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HomeMy WebLinkAboutCLE200600306 Application 2015-06-01Application for -``�� f' Zoning Clearance ; r OFFICE USE ONLY -{Zoning Clearance = $35 CLE # G CO Jv(No PLEASE REVIEW ALL 3 SHEETS Check# _7,3a Date: IQ" 0�- Receipt # JaS31 Staff- PARCEL INFORMATION Tax Map and Parcel: �.V / 1 ` ► l Existing Zoning P Q Is C Parcel Owner: S 1 rn 0 I I .J e80 r- O Parcel AddressX &C e-012-0 city y Nd is Nap O /i s State -r/V Zip Y4QQ (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Po/%//7 4L((/% 2 4 LRrw)�C Address Le' / /%"� /�(%e <<�r N. City ae State _ Zip _1l Office Phone: (0),��t� GI �/)/) Cell # Fax #,SjQ -,S2LEL6E-mai1 (-d & P 0 l%ascwe lw n"'Tj APPLICANT INFORMATION Business Name/Type: %�'Q%%��� /��'Y)i? 1 � %QCU sz"�� Previous Business on this site Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any additional information that you can provide: n 4 (lU P.C(>. IA L'le *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. Signature Printed( f PROVAL INFO ATION ffBackflow Approved as proposed [ ] Approved with conditions prevention device and/or current test data needed for this site. Contact ACSA, 9 7-4-ViC 6y Device and/or No physical site inspection has been done for this clearance. Therefore, it is not a dete ti ff #& '&tl��g site plan. Contact ACSA 977-4511, a 119 [ ] This site complies with the site plan as of this date. Notes Building Official Date I Zoning Official Date X�D'� Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 5/1/06 Page 2 of 3 Intake to complete the following: ❑ YES 11KO Is use in LI, HI or PDIP 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 LK 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 E9/YES ❑ NO Is parcel on septic o public sewer? ❑ YES []"NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Reviewer to complete the following: 7Sq footage of Use: C J YES ❑ NO 'gro // Pd )a Permitted as: JW OAA Under Section: �6 , Supplementary regulations section: Int a Parking formula: Required spaces: GAP" / yUhl �� ruAu ❑ YES © NO I (�� Items to be verified in the field: Inspector: Date: ❑ YES ❑ NO J—VOw Notes: Will there be any new cons?ruction ction or renovations? If so, obtain the proper Permit l/ '� Permit # 1 C.QJJ� Zoning 'Tech to complete the following: Violations: ❑ YES If so, List: VNO Proffers: ❑ YES [a7.G0 If so, List: Variance: ZYES If so, List: VA- ❑ NO SP's: ❑ YES�O If so, List: 5/1/06 Page 3 of 3