HomeMy WebLinkAboutCLE201900193 Application 2019-08-27Application for Zoniin2 Clearance°�A`
CLE # 2Z�lG — I G�
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# G;.S Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 07800-00-00-06200 Existing Zoning CQ e - �' (
Parcel Owner: Sandollar Ltd
Parcel Address: 1648 State Farm Blvd City Charlottesville State Virginia zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Preston Morris, Jr.
Address : 1648 State Farm Blvd City Charlottesville State Virginia —Zip 22911
Office Phone: () Cell # 804-539-2723 Fax # E-mail pmorrisjr@systeml3.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Lunch Monkey Designs, LLC
Previous Business on this site Commonwealth Clinical Systems, Inc.
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
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;_aAn__nliA@ retail store, the
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*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 ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Preston Morris, Jr.
AP OVAL INFORMATION
[tf Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] 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
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
ineA +��marle Cl,ley
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Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Is /
Is u e I, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y sere
Wi 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 oaliepartmn't
s wate
If private well, provide Heeform.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or p is sewer?
Y/N
Will you be putting up a new sign of any kind'? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there 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:
N 06 i Ce_
fitted as:
Under Section: X211 , ( CW C (
Supplementary regulations section: r—
Parking formula: o[�
o n .j
Required spaces:
S►iLC G �
Y/N
Items to be verified in the field:
Inspector:
Notes:
Viol s:
Y/N
If so, Li
Proff
Y /
If so, ist:
_ l✓1 1 k �wyl /
Var' ce:
Y
Ifs , ist:
SP's-
y /p
If so, ist:
Clearances:
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SDP's
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Revised 11/1/2015 Page 3 of 3
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