HomeMy WebLinkAboutCLE201900255 Approval - County 2022-06-24i,PPROVEt,
C the Albomarle Couty
r;u�ity Development D
Application for ZoningClearance
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CLE# a—OL�I� SS Cti 2u1q' 255
OFFICE USE ONLY ol2Sl I�1
PLEASE REVIEW ALL 3 SHEETS
Check # G— Date:
Receipt # (p o Staff:ywc,
PARCEL INFORMATION
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Tax Map and Parcel: 060000000040C1 Existing ZonineCommercial
Parcel Owner:Townside East LLC
Parcel Address:2214 Ivy Road STEM City Charlottesville State VA Zip 22903
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
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Address : 901Y l vbj^ � d, � I06 City V) °t, State A Zin2?�D�
Office Phone: C__) Cell # Fax # E-mail -5k61 N C Q lt4iffV M Af&Ve
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APPLICANT INFORMATION
Check any that apply: _ Change of ownership of use ofnameNew business
CChange
,J-Change
Business Name/Type:JJ//ri1LlG{l� ��1�1L S �YGI!/t
Previous Business on this site In /" (—
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any ad ttional inform lion that ou can rovide: I
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*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, and that I will abide by them.
Signature Printed
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AP OVAL INFORMATION
[LrApproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] 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 with the site plan as of this date.
Notes:
Building Official Date
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
0 2 9 l cl- 0 2 5% Z Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y /9
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi6thbe 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 is wate
If private well, provide Heal artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Reviewer to complete the
footage of Use:
_Y" N tit al G�F�
Permitted as: 2 � ( e
Under Section: 2i(t Z, ( (2gr,
Supplementary regulations section
Parking formula: I (AQ
Required spaces: It
5V)Ve s
Y/N Y
Circle the one that appli Items to be verified in the field:
Iss� parcel on septic o ublic sel! .
Y)N
tll you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # )52,007 - O 26 S Z Inspector
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Viola pits:
Y/
If so, ist:
_
t LL
Prog/�, s:
Y/V'
If so, List:
Variance:
T /N
f so, List:
5i9k %�
P's:
N
f
so, List:
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Clearances:
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Revised 11/1/2015 Page 3 of 3
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