HomeMy WebLinkAboutCLE201300146 Legacy Document 2013-09-13s�
Application for Zo ", �* .. er• y cc
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CLE # _'I?) 14-5 r
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USJ( Y r y,
Check # t Date: t �
iReceipt # Staff:
PARCEL INFORMATION ,y
Tax Map and Parcel: ( 55— 6 o- ,-�4/- (�J1pA /' Am A )Existing zoning AA
Parcel Owner: h4l-yo Y4 9W[ 4 /z
eft77s�'$�; L LG
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Parcel Address: s49 i &QGF Qj . City E7 State V1 Zlp�
(include sum floor)
PRIMARY CONTACT
Who should we call /writo concerning this project? DA V /13 b&Q 5:914&
Address.-1005 h.I��ft�•�Gt'^ city t✓ OZ.6 State V zi Z9
�_� � Z
Office Ph net D Cell # r. -945 x #
`T q 73'Z �1t7t7 "U
APPLICANT INFORMATION
Check any that apply: Change of owt)ersilip Change of use ` '-'Change of name Neiv. business
Business Name/Type; r
Previous Business on this site S' 04 e
Describe the proposed business including use, number of employees, number of shits, available parking s aces, number of
vehicles, and any additional informntion that you can provide:
*This Ciearonce will only be valid on the parcel for which It is approved, Tfyou change, intensify or move tho use to anew location, a now Zoning
Clearance will be required.
• I hereby certify ills olvn or havo the owner's permission use the space indioated on this application, T also certify that the information provided
Is true and accura t tha best o my owl .1 ve ad the conditions ofapprovel, and Iunderstand them, and that.I will abide bylhem,
Signature < Printecif eIALt 7
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions j ] Denied
[ ] 13ack1low prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] No physical site inspeotion has been done for this clearance, Therefore, it is not a determination of compliance with t1w existing
site plan,
[ ] This site complies with the site plan as of this date.
Notes:
Building Official _ Date `1 tom?
Zoning Official Date
Other Official Date - C
County afAlbomnrie liepartment ot-t:ommuntty Uevetopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 711 12011 Page 2 of 3
Intake to complete the fol
Is /OiIs u in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
� /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 i i 6
Circle the one that applies -
Is parcel on private well or p lic :Wza r?
If private well,.provide Health nt f orm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p ie se .
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnino to complete the followini?:
Reviewer to complete the following:
Square footage of Use: �L3 a-6
6) /N
Permittedas: ��CeS a ✓� �� �� C �(U�S�
Under Section: IJ l
Supplementary regulations section:
Parking formula:
Required spaces: y
J
It
Ite o be verified in the field:
Inspector : Date;
Notes:
Viol(a-'ons:
If so;`List:
Proffers:
If so;`eist:
Varia ce:
Y /
If so,Zist:
SP's
Y/6
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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