HomeMy WebLinkAboutCLE202000020 Approval - County 2022-06-24.rr .W..*,r_
Applicati
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REVIEW ALL
PLEASE 3 SHEETS Check # ��-I U�'1 Date:
ceipt S
Retaff
# ��� :
PARCEL INFORMATION
Tax Map and Parcel: i� A-2 - c)0c -- 0®1 0® Existing Zoning 116 /J 1 p6kL,
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Parcel Owner: ��o`SS o� ytorl�P c7 •�S
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Parcel Address:_ 1 Jr3 I4:G�� F -City cat Oo�'— State 4' Zip u
(include suite or floor)
PRIMARY CONTACT
Who
should we call/write concerning this project'? _ 1r` O 5 S L �, QJ��
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Address: 5 3 7-1 1' \t 1 L Up1�pp1 t ,city Cif ()ZQ State V Zip ��
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Office Phone: " -�c ] D *ell # 9U� Fax # E-mail -F Pit/ pJl�
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APPLICANT INFORMATION
Check any that apply: Change of ownership _ Change of use _Change of name New business
Busiuess Name/Type:
Previous Business on this site
Describe the proposed business including use, number of employee number shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: �1 �(j� M
'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.
's ission to u the space indicated on this application. I also certify, that the information provided
I hereby certify that I own 2Lhu2LIlle 7XiedgM.n.
is and ac�a a best
of approval, and I umderst�and them, and [hat I will abide by themSi
5conditions
�e
ature \ ---Rrinted K'osj L
APP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ]Denied
[ j Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x117.
[ j No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ j This site complies with the site plan as of this date.
Notes:
--------------
Building Official i Date
Zoning Official 1 (0 � a 6
Date
Other Official Date
.,..UULY u. , uemune ueparrmenr or community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y 4Nl
Is u 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 or ublic wa
If private well, provide Hea artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or pub c sewer?
Y/
Will u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /l Wil re 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: !M
t ermitted as: h�f(�t5 N I (Ito
Under Section:
Supplementary regulations section: /
rf�ni I ODD
Parking formula: f A, , I f l
Required spaces:
Yale
Ite verified in the field:
Inspector : / Date:
Notes:
i lations:
Y/N
so,Y,ist: n/�/��jr'� _ �
c V-14-,
Pro�fie?, .
y/
Ifs "/� t:
Var' c :
Y/N
If SOMA: A:
SP'sr-,
Y/(L1)
Ifs t:
Clearances:
SDP's
401
Revised 1 I/1/2015 Page 3 of 3
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