HomeMy WebLinkAboutCLE201400103 Legacy Document 2014-06-09Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE, USE ONLY J
Cheel( # Z S % Date:
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Receipt # 59) Staff:
PARCEL INFORM I C.
�� O 0 Jd Existing Zoning
Tax Map and Parcel: ' C� ` U n
Parcel Owner: + t 2S
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City A✓C)k4QS VAeState Va Zip';'It ?0-1
Parcel Address:
O(i clu suite or fl r
PRIMARY CONTACT ,
Who should we call /write concerning this project?
Y0 C, city S�Of State t Zip L �
Address: _
Phone: �a�! 7 (03 73 Cell #7!3 �,g to 5,4a x #7!3 a� 'le03o6 E -mail er d tv122. t )S-i 14 : t! Q2&^I
Office
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Pm-eAica( �6,s1ca(
fn r �t t C
Previous Business on this site r & UJ
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
A6 Sh & �U
vehicles, and any additional information that you can provide: 3 �I c>+%pS i4k aI(S'65 - ,c?-
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move tie use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I o 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 e' best of my kno dge. I have read the conditions of approval, a d I understand them, and that I will abide by them.
Signature Printed )'� 0 � tit�Z
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, 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 �— Dates �7�C
Zoning Official Date 9
Other Official Date
County ol'A.lbemarie Department of t:ommun►ty iievewpix ut
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/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
Circle the one that applies -"
Is parcel on private well public water
If private well, provide He e a nt form. -- - -- -
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or tiblic sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
W it l there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
r7 — — — —T—J.— J.L- 15.11.....:--
Reviewer to complete the following:
Square footage of Use: ' 7-3 9 V.
,"YJ / N
Permitted as: ..A e„ Q ^C,4
Under Section: --3.2
Supplementary regulations section:
Parking formula:
IQ c, L,�b
Required spaces: A)
Y/ .
Items o be verified in the field:
Inspector : Date:
Notes:
U11111 ;4 LU L%U111 10LC Liac avaavrraaa O
Viola ions:
Y/
If so, List:
Proff s:
Y/'
If so, ist:
VaR ice:
Y
If sst:
SP's•
Y /(�N
If so, List:
Clearances:
SDP's
Revised 7/l/2011 Page 3 of 3
Approximate Total Square Footage- 2,394
EXISTING I Date: 06.04.14 Scale: 1/8" -- P.W
Location: 1406 Greenbriar Place, Charlottesville, VA 22901 Revisions:
THE FACILITIES GROUP, INC., 1300 W. SAM HOUSTON PKWY. S., STE. 300, HOUSTON, TEXAS 77042