HomeMy WebLinkAboutCLE200700292 Legacy Document 2014-05-06Application for K~ " =T`� -�
Zoning uilding Permit
ng Clearance #2007 - 2095
OFFICE USE ONLY,
Zoning Clearance = $35 CLE # 960 70
9 a
PLEASE REVIEW ALL 3 SHEETS Check # O Date: nn -0%
Receipt # G 9'1 H 0 Staff: V I
PARCEL INFORMATION
Tax Map and Parcel: 32 -1 9G Existing Zoning PDIP
Parcel Owner: University of Virginia Foundation
Parcel Address: 1 000 Research Park
B_l�,Oty Char lottesviNbla VA Zip 2 % -9.1 1- ` - - - --
(include suite or floor) Suite 1 1 0 I
PRIMARY CONTACT
Who should we call /write concerning this project? Deborah van FPr _qPI
Address: P-0- Box 400218
City Char lottesvil9tete VA Zip22904-4218
Office Phone: 6-3-4) 924 -0696 Cell# 531 -1936 Fax# 982 -4852 E -mail dv5g@virginia -edu
APPLICANT INFORMATION
Business Name/Type:
First Run-Cafe
Previous Business on this site Padow' s Hams & Deli
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
Restaurant
*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' ermission to use the space indicated on this application. I also certify that the information provided
is true and accurate to th I have read the conditions of approval, and 1 understand them, and that I will abide by them.
f —_ j
Signature Printed �L� fAK V alyl s44
APPROVAL INFORMATION BacknOW Device andJa
[ ]Approved as proposed [ ]Approved with conditions i VuMmteTest Data Need
[ ] Backflow prevention device and /or current t st data needed for this site. Contact ACSA, 977- 500MM ACSA 77-Q _
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determinati pmftnce.� a a g
site plan.
[ ] This site complies with the site plan as of this date. ,
Building Official
Zoning Official (A
Other Official _ / �m
Date o
Date J -7
Date l( 6 /0—/
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
Intake to complete the following:
❑V�YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
6 YES ❑ NO
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not b/e�gli i � we receive approval from Health
Dept. FAX DATE �" !i
r �
❑ YES ❑ NO
Is parcel on private well or ublic wat r?
If private well, provide Heal ment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
❑ YES ❑ NO
Is parcel on septic or p blic sew ?
❑ YES [ZNO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. J � , �n , _, I
Permit # il I il,(i(�' "Xz: ,(J(,(i V (�C'
❑YES [�NO
e k
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Gonina l een to, complete the tollowina:
Violations:
❑ YES ❑V NO
If so, List:
Variance: ,.
❑ YES [] NO
If so, List:
Reviewer to complete the
Square footage of Use: z 1 �4 Oa
MYES ❑ NO
Permitted as: Q aJ4,
Under Section: &,
Supplementary reg4ations section:
IA
Parking fort I A ` ��� U-r>,9
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
511106 Page 3 of 3