HomeMy WebLinkAboutCLE201300201 Legacy Document 2014-01-15A pP licati ®n i ®r Zoning— Clearance
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CLE # qtL3 - �Q
OFFICE U E ONLY
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning CO m merCt c1
Parcel Owner: i�o knu n LLC
Parcel Address: '7, a 10 col City Char c)4ye6.1[ ate V Ar Zip,-).:;e i
(include suite or floor)
PRIMARY CONTACT
M is c10
Who should we call /write concerning this project? H c ry ndk;-
Address: ?j13Gi `J�Gnu �C�[ n 0-cl City G'V-r_tr I044eSv;I State VA- Zip aac) l
Office Phone: Cell (! 0c) 7659Fax # E -mail [mLi r i a m h Q q 4? 4 ma i Cp
APPLICANT INFORMATION
Check any that apply: 'Change of ownership Change of use Change of name New business
Business Name /Type: A\ CdidbO n C V-�a rCOA r04 l 56e r C �i t CK2,r)
Previous Business on this site ?C'i po\ JOt) k ,5
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: CoSuo k G ui ccir, ACy w % rh
AGKe pub . -Vakc[\ aAk One •kim-a i bt 5,pnce`3
*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 �v ���r, Printed t a m a n oleZ-
APPROVAL INFORphee
[ ] Approved as proposed [ ] �pr with conditions owl
[ ] Backflow prevention dec t test d ne or this site. Contact ACSA, 977 -45 1, x117.
[ ] No physical site inspect o for thi lea c Therefor e, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with of this te.
Notes:
Building Official Date zS
Zoning Official ./ .✓ ��' Date L &I -/3
Other Official Date
County of Albemarle Department of Community 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/N
Is use in LI, Hl or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
(0/ 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 7 &Z, . ?
Circle the one that applies
Is parcel on private well or �117w20
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 #
7nninrs in PAMnln4r> Ap fnllnwinff-
Reviewer to complete the following:
Square footage of Use: 2 0 J
Permitted as: 1191
Under Section: 2y I
Supplementary regulations section:
Parking formula:
Required spaces: i
Y / I2
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
If so�List:
Proffers:
If so, ist:
Variance:
Y /l
If so, List:
SP's:
Y /
If s , List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3