HomeMy WebLinkAboutCLE201900208 Approval - County 2020-02-03Application for Zonin Clearance""
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CLE # -
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OFFICE USE ONLYd ��r
3
PLEASE REVIEW ALL 3 SHEETS
Check # Date: D !�
-CP9.a�
Receipt # DID Staff: "
PARCEL INFORMATION
Tax Map and Parcel: Q 9(20 —050' —0 7—% dJ %� 0 Existing Zoning
ArN C
Parcel Owner:
�
17
Parcel Address: a` 100 City (�'
�Gw SVI I State Zip
(include suite or floor)
PRIMARY CONTACT
Who should 1w/e call/mitt 1concerning this project?
D4
Address: /�
` Y `I V `'t l�� City t.�°' State VA Zig1 V I
_1!
Q; —
Office
Phone: �) Cell # , l l�x # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: A e d 6dmj
-
Previous Business k J to
on this site .
Describe the proposed business including use, number of employees, number of shifts, avail b e parking s aces, nu ber of
vehicles, and any additional info mation hat you can provide/ /� .Q,y„%' a
ale ;o
*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, that I will abide by them.
Signature Printed i✓
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 11, xl 17.
[yrNo 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 /U10%
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
�,. .r.+i
Intake to complete the following:
Y J/ N
use in L1, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 <J� ,), , ,;
Circle the one that applies
Is parcel on private well o public water
If private well, provide H It ent form.
Zoning review can not begi ntil we receive approval from Health
Dept. FAX DATE
Circle the one that ap es
Is parcel on septic o public sewer?
Y / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. P ermit# � `� �1►►��
Y/ / N
►II there be any new construction or renovations?
If so, obtain the, roper Permit.
Permit # 910 )a— Ml n -'
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
e Ull
-I3ermitted as:
Under Section: �� • --�A n �%
Supplementary regulations �secti G,�
Parking formula: Jj Jf " \zl�� j 6f 1v1 / t
Required spaces: 31�
Y / N
Item be verified in the field:
Violations:
Y /
If so, t:
s:
Y N
Co,sList:
IN
Var' e:
Y /
If so, ist:
s:
I
N Y
f so, List:
Clearances:
SDP's
Revised IN /2015 Page 3 of 3
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