HomeMy WebLinkAboutCLE201300237 Legacy Document 2013-10-25Application f® Z®ningy Clearance
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CLE
PLEASE REVIEW ALL 3 SHEETS
OFFICE US LY
Check # , Date: 4
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 6� I tj – 3 Existing Zoning 4
Parcel Owner: 14&(R-t- .L N ti 4gQ II- C-15_" 7 CC1WD1 +A_)
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Parcel Address: J ( �� �l^. ��� C;t., �c r,` yif� State V y Zi
(include suite or floor) r
PRIMARY CONTACT
Who should we call/write concerning this project? l�
Address:- (9(;- 2 -t v ,,r b eJ -L V City ��� i- �� �s t�l� State (:i oq Zip
Office Phone: C�1� �},2q _g l9, Cell # '?0(0
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use. Change of name ✓New business
Business Name /Type: e I lLce– a 15 & FCLr-";1,z
Previous Business on this site vn – k:A_ kf r%A1O-K
Describe the proposed business including use, number of employees, number of sbgf available parking spaces, number of
,s
vehicles, and any additional information that you can provide: b r:.Je,7eL-
*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 accur t the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �\ • --J� Printed C���� �e� •�c�rt
AP OVAL INFORMATION
[WAppproved 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 j 0 %r� 3
Zoning Official / Date S'
Other Official Date
�.vuaaaJ va [ vwJUUAAC IJCpslrLmeLL OI c.:Ommun,ty Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y /ff)
Is use in LI, HI orPDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y I®
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 orcp lic water?
If private well, provide Heal eeparnnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE _
Circle the one that applied___ _.
Is parcel on septic o public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
�IN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the fnllawin6-
Reviewer to complete the following:
Square footage of Use: 27
(9/N pp )
Permitted as: M evt i (A/ (� C."
Under Section: iZ -2' '
Supplementary regulations section:
Parking formula:_
-1
Required spaces:
13
Y N ) :a=
ItAlabe verified in the field:
Inspector • Date:
Notes:
Violations:
Y / N
If so, List:
Proffers:
Y / N
If so, List:
Variance:
YIN
If so, List:
SP's:
Y/N
If so, List:
Clearances: i`
SDP's
Revised 7/1/2011 Page 3 of