HomeMy WebLinkAboutCLE201700240 Application 2017-10-30 (3)Application for Zoning ClearanceA't�
CLE# 40�q-AQ6
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # ifiam Staff:
PARCEL INFORMATION $C/IrII
Tax Map and Parcel: Existing Zoningr[,n4 (�t�xryea,
Parcel Owner:
Parcel Address: $(c �t7 ��`� , �� City C°,�x&INPSl,A\f; State L Zip
(include suite or floor)
PRIMARY CONTACT,�
Who should we call/write concerning this project? 1r1, a rr,-� M—eo
Address:(GUc, �f`r.�;1t.Xc'� \igrc city elr_r�r,C�F;t,,�iQ, State UCt Zip. `GI
Office Phone: U Cell #(A'-6:)y Fax # E-mail (AftlLCAC}t
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: A41( & \SCuk<j / 1-rk li^ EE:A L-Akay-C
Previous Business on this
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: t-rv% _ r,�W- Crn&j4 ze nr-4
CIA,
*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.
1 hereby certify that 1 own or have the owner's permission to use the space indicated on this application. 1 also certify that the information provided
is true and accura to best of y kn ge. I have read the conditions of approval, andGGI understand them, and that I will abide by them.
Signature Printed I r�(R(n C nn
APPROVAL 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.
(,]'1�10 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 W&OW, Date
Zoning Official Date �6J �j, I
Other Official Date
e:ounty of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
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Intake to complete the following:
Y /�v
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil 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 blic water?
If private well, provide Healt ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a
Is parcel on septic nblic sew
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Per 't# p SPIjGyifl'i�'r �t'101
Y / N 1I
Will 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: a, SJ f� L
Y/N ll L 1
rmittedas: C,A sr��i� 6�ihfny�GIQPQtP� S
Under Section: a S• Z 1 Cl)
Supplementary regulations section:
ZZ- L • 1 (CI 1—)
Parking formula: S � o
hFinU) Cl'lit Ll"'
Required spaces: /
n% (✓ -) P P Zoo D' 1
Y
Ite o be verified in the field:
Inspector Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
if so, List:
Vari ce:
Y / N
Ifs St:
SP's:
Y / N
If so, List:
U60— yl i
Clearances:
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SDP's
Revised I I/1/2015 Page 3 of
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