HomeMy WebLinkAboutCLE201700259 Application 2017-11-21 (3)Q�
Application for �i'An/(Z4\ eaa11ce
0�,�
♦✓
cLE � zU 1-7
r�RGII;�P
PLEASE REVIENV ALL 3 SHEETS
OFFICE USE NL V
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0(,3106 64 OCR /QJ6,Q Existing Zoning C(Jyj C1
Parcel Owner: 5-Uk-A ( -A Y 1„ L t'
Parcel Address:36-10 4M560 CT S7C �of nn
City `-ttihlR-�-�� 1 �1i1N..�tatey H Zip �Zy� j
(include suite o floor)
PRIMARY CONTACT
Who
should we call/write concerning this project?
Address : Sgg ( pAp_-V_ pq) Cite C R-0 1_'1 Statey►^I Zip v2�}
--
U S �8�g07OF
Office Phone: Cell # ti I Fax # E-mail (� o v,� gtMg t • t
�� �( 1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
�e , �
I Business Name/Type: Dp jP���� l.M� — l�S$� 1 t''Yl:l" y_
C'h
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:S106-LE 0'-Jwe "
*This Clearance will on]), 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 pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of m e. I have read the conditions of approval, and 1 understand them; and that I will abide by them.
Signature Printed V T6 b 1 f� q---
AP AOVAL INFORMATION
[ „]'Approved as proposed [ ] Approved with conditions ( ] Denied
( ]Pwickflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x 1 17.
[ '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 Nvith the site plan as of this date.
Notes:
Building Official Date /
Zoning Official U40Date j[ IZT/ I
Other Official Date
i
9N
County of Alhen;arle Department of Community Development
4W ?Jclntire Road illc% VA 22902 Voice: (434) 2-96-S832 Fax: (434) 972-4126
Intake to complete the following:
Y .N
is use ►n LI, Hl or PDIP Zoning? If so, give applicant a Certified
Engi er'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 or public water?
If private well, provide Hea t Department fon3).
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
will Q)u e putting up a new sign of any kind? If so; obtain proper
Sign pennit.
Permit
Y / N
Will there be any new consimciion or renovations?
If so, obtain the. proper Permit.
Permit #1
Zoning to Complete t11e followin
Vio ons:
Y
Ifs ►st:
i�ar' ce:
Y N
Ifs si:
:CJearances:
I
i
— —------------- —
I
Reviewer to complete the following:
Square footage of Use: 1()4 2—
N
itted as: piOf Kglwn 1fi1 0 —c
Under Section: ZZ.L , . Ib ( I
Supplementary regulations section:
Parking formula: 1 r 1 1 1
�2�0 ° �cl►e�,} fi �emP>
Required spaces:
ll (/ N
Ite to be verified in the field
Inspector: Date:
Notes:
Proffers:
Y
Ifs tst:
Ls-
EPE�-E��
If ►st:
SDP's
pe�h"t- + <�f-