HomeMy WebLinkAboutCLE201700255 Application 2017-11-21 (3)Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # y t�'l`/,T 3 �LDate: fl s'// 9
Receipt # Z G Staff: ✓'-�i
PARCEL INFORMATION
Tax Map and Parcel: 0%-7C0-CEO-00-0yp gQ Existing Zoning Ll -�nrx ✓�
Parcel Owner: __VAOF 0 � V 1ijg tin 16L
Parcel Address:1-17o Bra' -Lay G, Cite a4'/daWjb State V� Zip
(include suit or floor)
PRIMARY CONTACT
W'ho should we call/write concerning this project? lJj C_0O✓1
Address Cite 6z�:a� State 4 Zip
Office Phone: Cell # X-`' Fax # /1Qr?-A—E-mail aCvsS xt.Kc. , o , �► �,at'
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use of name New business
' /—Change
Business Natne/Type: $4M W_ VAL
Previous Business on this site a: 6a V 1 GG�
Describe the proposed business including use, number of employees number of stir ts, available parking spaces, number o'
vehicles, and anN additional information that Non can provider
*This Clearance will only be valid on the parcel for NNfiich it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance \vill he 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 accura the best of my knowledge. 1 have read the conditions of approval, and 1 understand them, and that I xvill abide by them.
Signature Printed ���� (/�ed✓��
APYROVAL INFORMATION
[ l Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Baskflow, prevention device and/or current test data needed for this site. Contact ACSA. 977-451 l; xl 17.
f.�,Xo 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.
Dotes:
Building Official Date
Zoning Official �^ 1C� Date 11 1 1 7' 1 7
her Official Date
LO
County of Albemarle Department of Community Development
401-Mcintire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
7
Revised 1 I'02,2015 Pace 2 of 3
Intake to complete the following:
Is
Is u5 . ' LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Yt W' 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 p blic wate
If private well, provide Healt en form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
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# a Str4(4E' �f11YM,�
L
YY ON
�
ere 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: 4
Y / N & S°/O
Permitted as: (} eaTlyW44,e 0 r )(
Under Section: 1,& Z- q
Supplementary regulations section:
Parking formula:
'Ien,� tV 06 vner, io noblic ((tSomel
Required spaces:
Y (/ N )
Ite be verified in the field:
Inspector Date:
Notes:
Vi?"i• Qns:
YqN,
If so, ist:
Pro s:
Y/N
If ist:
Var' ice:
Y.% N
If ist:
SP's:
N
so, List:
Zvt7—IN
cq — 13
Clearances:
SDP's
"�cj "163 tiC 4Z
Revised 11/1/2015 Page 3 of 3
Exhibit A
Mark Tenant Space on drawing.
Lease Agreement - VAS of Virginia-generic170322.docx 22 Of 24 v] 70227