HomeMy WebLinkAboutCLE201900225 Approval - County 2019-10-30APPRNEL, l
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Application for Zonin"MT eat4ill�;P!
Clearance
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CLE # - _�j
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REVIEW ALL 3 SHEETS
OFFICE USE ONLY ��PLEASE
Check# CG Date: (2-4
Receipt # Staff:
PARCEL INFORMATION A
Tax Map and Parcel: 6W& 0Z-� A ^ 6Ql00
Existing Zoning
Parcel Owner: 1 ��' uU1 66��� l�� 1 ��Y�(� ,
Parcel Address:) Z ) 5 Sewtl► I0 =��c'l' _ Ciitt C,L) [ I [t State Yft
Y Zip ZG( ()
(include suite or floor)
PRIMARY CONTACT ,,
Who F O �( 2 h
should we call/write concerning this project? e Q l./
Address: I Z o(D ho Ml es Ckv Q- City C/ u ' I UG( O
State Zi P
Office Phone: ( ) Cell # 7� ! �� 'y3pax # E-mail
APPLICANT INFORMAT ON
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: �� � 1 � S NA-o Se cy t Le -
Previous Business on this site ro ijo"eii �A o p
Describe the proposed business including use, number of employ es, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: _ YY\11 i � 511 oz-�, C�\k b,5,-
_ —
*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 / / 4C z 1 /
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, 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
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y / N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
Wil ere 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 public water?
If private well, provide 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( eptic or public sewer?
Y,,/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y`Nj
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:
—T
/ N 1 ermitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
ems to be verified in the fie .
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y / N
If so, List:
SP's:
Y / N
If so, List:
Clearances:
SDP's
Revised 11/l/2015 Page 3 of 3
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