HomeMy WebLinkAboutCLE201800165 Approval - County 2022-06-28>PPR0VED
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PLEASE REVIEW ALL 3 SHEETS
OFFICE lJ ON
Check # Date:: lY
Receipt # Staff:
PARCEL INFORMATION
Tax MCA
ap and Parcel: �llt�( fV�!a�= � ' I�Gt i 10 Existing Zoning(' p
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Parcel Owner: `-Ca 7.
Parcel Address: � t0c' 1x r vt/ City C bQ v ��jQ�,� 110 State J fA Zip (— 11 p
(include suite or tloory
PRIMARY CONTACT
Who should we call/write concerning this project? L'. vl�__��r
Address : �3H LD S Ivy City 93=%v iC,M 0U State \ELF Zip 2Z9y
Office Phone: (tt ) Z y4 _ Loikep # Fax # E-mail
APPLICANT INFORMATION
Check any that apply: _ Change of ownership Change of use _Change of name business
Business Name/Type: �C, I'-1'(`1�1 /�!� +✓� ('
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INew
Previous Business on this site bbbbbb
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: Z -
1pn
LI
*This Clearance will on be valid o 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 req red.
I hereby certify th, 1 own or e th owner's permission to use the space indicated on this a placation. I also ceru. information provided
is true and acair, c to the s \f i kn , dee. I have read the conditions of approval, at understand them, at I will abide by them.
Signature Printed
I FORMATIONproved
VAPPPiIOVAL
as proposed I I Approved with conditions I I Denied
I I Backtlow prevention device and/or current test data needed for this site. Contact ACSA, 977451 1, xl 17.
I I No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing -
site plan.
I I This site complies with the site plan as of this date.
Notes:
_;O*ZE�
Building Official Date
Zoning Official Date
Other Official Date
u...y o1 n'oeuiane vepartment of community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 2%-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y / N
Is use in LI, HI or PDIP zoning If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there 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 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 septic or public sewer?
Y / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to completethe following:
d
Square footage of Use: —T Tp V Is 9 q
ennittedas:
Under Section:
Supplementary regulations section:
Parking formula: I D
Required spaces:
Y / N
Items to be verified in the field:
Inspector: / Date:
Notes:
Violations:
Y / N
If so, List:
Proffers:
Y / N
If so, List:
Variance:
Y / N
If so, List:
SP's:
Y / N
If so. List:
Clearances:
SDP's
Revised I I/1/2015 Page 3 of 3
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Room Name
Square Footage
I)esi,ll Room
261
Balhroom
3 i
Kilrhen
Vain Room
3!3.i:""�
Closel
Sales Room
277. i
U mralions Room
169
1lallwac
28
\V'eh Room
130
Slainwll
10
Landill"s
106.2.)
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