HomeMy WebLinkAboutCLE201400231 Legacy Document 2014-12-02Application fl&Zoning Clearance
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OFFICE US k LY
PLEASE REVIEW ALL 3 SHEETS
Check # Date: - ` 1
Receipt # Staff:
PARCEL INFORMATION l�C
Tax Map and Parcel: �7 9 / 3 /� Existing Zoning
Parcel Owner: C oz_,_ 777)m"�z Gj��/Z L L- G
Parcel Address:,;?jS3 ✓'1 /C /,1,,nO/V/j /2/) City State V Zip
L (include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address : City C State \-1,4 ZipZ2-1ll
Office Phone: (!456 Cell Fax � ,FV77E -mail , le kV 7SX0,q 1d-Cv
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ✓ New business
Business Name/Type: ss 4^11V61<
Previous Business on this _: dge_T5"CVCLC
Describe the proposed business including use, number of employees, number of shifts, available arking spaces, number of
vehicles, and any additional information that you can provide:C/!Wte% C _1 Fal PS✓ 5 l
one,
*This Clearance Vill 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 ac ur to tee est of my knowledg . I have read the conditions of approval, and I understand them, and that I will abide by them.
G� i��Y✓ Printed e,1 //J
Signature k
APPRO AL INFORMATION
�N'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 ((:L (p (
Zoning Official _ Date //1% 41 -61
Other Official Date
County of Albemarle Impartment of �_ommumLy LevCU,lJiuci,L
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
M
Intake to complete the following:
Y / O
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 6)
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 o ivate we or public 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 r 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, obt ' t� r er t
Permit #
.x__.__ e e a EL
Reviewer to complete the following:
Square footage of Use: / L9 %
�/N /
Permitted as:/ �✓�iY 6� �Sj 1`�I
Under Section: Z q ,'2 •'
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
uvaaau
Viola ons:
y/6
If so, List:
Proffers:
Y /(N
If so, ist:
Variance:
Y/0
If so, List:
SP's:
0/N
If so, List:
d Z —
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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