HomeMy WebLinkAboutCLE201400061 Legacy Document 2014-04-18ply' �r01
Application r. ®nin eaJL ce
CLF # -
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY r•/
Check # 5 �� Date: °" OS 2
Receipt # Staff:
PARCEL NFOR T�
� �� �✓
b' Existin g Zoning
Tax Ma and d Parcel: ) �����
a
Parcel Owner :N
Parcel Address: j'Djftr 5e&aa, P Y City eo �I'�— ...__— State L14. 2�zye
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? s� --_tj 42 f;AS -e
Address: �f'Y ��� �1�j 7 ,S f L� ity [ t� `� �'e- State v %ip
Office Phone: (M5 -6 MCell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: :c& / �� �'s�'� ✓� '4 .Sorg ����
Previwis Business on this site PCtl_� -1 Qt,,t,c 1-f -5
Desrri'loe the proposed business including use, number of employees, n;Pber shifts available parkin saes, number of
vehicles nd any additional information that you can provide: �� DEC
Wee— S,oaei T
"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 accura c to the best of my knowle e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed IvILVnA /'t rTVA L - EA 1'yyVe%r
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ]Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x1'17,
[ ] 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 r Bate(
Zoning Official Date
Other Official Date
County of Albemarle Impartment of Community ueve;opmenL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972.4126
Revised 711/2011 Page 2 of 3
Intake to complete the following:
Y I�N,,
Is use LI, [ {I or PDII' zoning? If so, give applicant a Certified
Engineer's Report (M) packet.
Y /N�j
Will re 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 ublic 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 o _lic sew
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
4 Y/N
ill there be any new construction or renovations?
If so, obj
Permit #
Zoning to com lete the following:
Reviewer to complete the following:
Square footage of Use: _._4<2b
ermined as: 7T oN+4 � 4p"Ge.�-
Under Section:
Supplementary regulations section:
Parking formula: / �
Required spaces: j
Y / N
Items to be verified in the field:
Inspector:
Notes:
Date:
i'
—c
Violations;
Y/
If so% st:
Proffers:
jY)'N
SO, I.,ist:
'Ziyly9 you I — I5
Varia ce:
Y /t1G�
If so, List:
SP's:
Y /
if so
Clearances:
SDP's
Revised 7/1/2011 Page of