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HomeMy WebLinkAboutCLE201900242 Action Letter 2019-10-18Xvy �6 1 sCo �359q 0-7 ( P N y Application for Zoning jjClearanc CLE #I — T"t� j,-."NET �.._ PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # C C Date: Receipt # Staff: C� PARCEL INFORMATION Tax Map and Parcel: (�7� V Q - QQ •— fL' Existing Zoning Parcel Owner: ' ` 4P4 tM(,,L64W,<Cs COIF Parcel Address: 140 5.pankm Dr City C%'1GIVIUI 5V4 k State ZipAQ1// (includes ite or floor) PRIMARY CONTACT L Who should we call/write concerning this project? u �1et +046J t fn5 Address : I4©S • i'r111k) C1 6U.- lD) City kA State Office Phone: ( ) Cell A4- 40-%?/Fax # E-mail ^ %LA-kilf VUL)61vr," V -ems ✓ 'kj APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business J� Business Name/Type: C a*r-✓ Aync1r;Ccal l��11 �I'do-k, LZ e Previous Business on this site 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: J erhp*LkcS daq :S/b+, 3 Deb-e_k _-> *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 J U )1g � udetn APPROV L INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. ;;oq,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 0417)` e(sm Revised 11/1/2015 Page 2 of Intake to complete the following: Is /,� Is u 1-1, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y N Wi re 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 o ublic water? Ifprivate well, provide Healt rr>ent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that apph Is parcel on septic public 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: C (00 S Y )N CWTI �e rmitted as: Under Section: —a4-- Z Supplementary regulations section: IL4 Parking formula:` ) ZoO 1f S F Required spaces: 5; Y/N Items to be verified in the field: Inspector: Notes: Date: Vio ons: Y N; Ifs ist: Prof s: Y Ifs st:,MyN� Dance: Y I N Itr1so, List: VO (9 9a 31 AIM s: Y / N so, List: Nd (, «bra (0 Clearances: Gle 2�fQ 3� SC1fif7�er-7—��z'>� SDP's p S�I 2��� Revised I I/1/2015 Page 3 of 3 . �- 1 9. �� l� � � 3 -� 0 0 � � � � � ---.1 _