HomeMy WebLinkAboutCLE201500126 Application 2015-06-23Application for Zoning Clearance
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CLE # S 2-G
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # CcAS \1.\ Date:
Receipt # l (9 0 Staff: >� .
PARCEL INFORMATION
Tax Map and Parcel: .1 O 0-5-G AZ - 01- 60 - 02-4-50 Existing Zoning pL�
Parcel Owner: ber ad,-_ CoaA414
Parcel Address:-5'R9t 1)ve.L City CeOeAe State\f,J. Zip Z 243Z -
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? �`G�CrJl
Address: "PO49X rc Cit46r10 14esuil e— State `!/fie Zip2zctoz
Office Phone: dmo) ISO .56' 3 C. Cell # Fax # Z -i5 -ZR -4. E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name/ Type:C(vrtr-SUn L A46_A4,0_rie.6vAIJC-IL&u-1g.lJ�Sf L�t�t,rccc��
Previous Business on this site .S M R_ L tG �oaaew
Describe the proposed business including use, number of employ number of shifts, available parking spaces, number of
vehicles, and any Additional information that you can provide: IcJurlsA%.-\-) i51 Caw kms, 2r—'es e.^d—
V0tua.kes5 , .-t rPr 14:L -a -T Par _e s C1u.0 s iWIejG 0! oW_— Ro bu-9ivits5 Lt. rS .
*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 best of my knowledge. I have read the conditions of approval, and I undersstand them, and that I will abide by them.
�accurathe
Signature Printed
APP OVAL INFORMATION
[k,,rApproved 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 T
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
IN
Intake to complete the following:
Is/
Is usQ LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/aeWill 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 is water?
If private well, provide Hea k L-Dartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic or ublic sew
Y/N
Will you e utting up a new sign of any kind? If so, obtain proper
Sign permit. I n `
Permit #
Y/N
Will there be ny new construction or renovations?
If so, obtain t e proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the fol owing:
Square footage of Use: If%
Y
/N(��rmitted as: op �!Q 11ably r,& kf
Under Section: 966 • oQ• fJ
Supplementary regulations section:
Parking formula:
11AAD
Required spaces: S / 1
It /(N) L/
Ite o be verified in the field:
Vioons:
Y N
Ifs
Pro er
Y N
If so,List:
Var
If N
If so, ist:
If N'
If so -, 'List:
Clearances: `,I i pn&� 14
SDP's
Revised 7/1/2011 Page 3 of 3
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