HomeMy WebLinkAboutCLE201400139 Legacy Document 2014-08-27Application for Zoning Clearance
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OFFICE ON Y
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # QCQBI15 Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel Owner: Edens
Parcel Address: 2035 Bond St. Suite 170 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Andrew Hoffman
Address: 7404 James Madison Hwy City Gainesville State VA Zip 20155
Office Phone: ( 703) 419.0470 Cell # Fax # E -mail andrew.jsquareps @ gmail.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Capital Teas
Previous Business on this site N/A (shell space)
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: Sale and consumption of Tea, and prepackaged food
Seating for 14 inside, patio seating for 10 outside seasonally, 9am - 10pm Sun -Sat, 3 employees,
*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 tha wn or h e the ner's permission to use the space indicated on this application. I also certify that the information provided
is true and accur e t the b of my nowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Andrew Hoffman
APPROVAL IN ORMATION
] 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 Date Z I Z 3( c
Zoning Official Date
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
Intake to complete the following:
Reviewer to complete the following:
Y /a Square footage of Use: 110 C�
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N 1
as: ka I
Y /
Will ere be food preparation? Under Section: A�q�i e� P/W e, 1C, d -�
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or ublic wa
If private well, provide Health apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appI'
Is parcel on septic or .ubli ?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
W i I I there be any new construction or renovations?
If so, obt ' tie perAT�
Permit # 11
Zoning to complete the following:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
(D /N
If so, List: / n
Proffers:
6/N
If so, List: -7
25M4 2or�/ -
2-61
Variance:
Y /N
If so, List:
SP's:
Y /d1
If so, List:
Clearances:
SDP's
�Y -5-7
Revised 7/1/2011 Page 3 of 3