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HomeMy WebLinkAboutCLE201500155 Application 2015-08-03Application for Zoning Clearance CLE OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt# oU—lZ' Staff: S' PARCEL INFORMATION Tax Map and Parcel: � ~ d C3 G-1 - ©C) Existing Zoning C I CoiV�w.ley>rad F Parcel Owner: �I r(.Q. k 1 _ 1 A) v 121 nA 2 F Parcel Address: ��5 �-*Y��v�r;�r j� j0� City C��vc�v;�� State (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address: I q City 6ticir State l/i Zip o22`7%� Office Phone:( ���-�)�� Cell # C/C(o^�S-e Fax # r� 3.51® E-mails fc�e�y� 1MyiY,iCi�Cit, c�Cd/k�l:crtf/i Co 1 � APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name ✓ New business Business Name/Type:ke �'exLLJ (L-SCLkl��s�uwc� A9 Previous Business on this 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: CT,'s;s [:'dv� aKiun So-nYice,S lmSkNivc.rS��SCxu4�t7;o L'trc�. ew �o err --o,» e�4 1 'K- F *This Clearance will only be valid on the parcel for which rt is approved. If you change, mtensrfy 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 accu tet a best f m owledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. Denied [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination site plan. of compliance with the existing [ ] This site complies with the site plan as of this date. Notes: Building Official Date Zoning Official Date_&4z�/A0e i 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: Y/Q Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/ Will Mere 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 qr ublic 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 or public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /® Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # mooning to complete the Violations: Y/S If so, List: Variance: Y / I f soaist: Clearances: Reviewer to complete the following: Square footage of Use: -25-3a S. F (0/ N Permitted as: d4j c-, (t Under Section: Z-�2• 2 Supplementary regulations section: Parking formula / Required spaces: AD Y/N Items to be verified in the field: Inspector - Date: Notes: P�yoffts: o �J / If so, List: �Z SP's: Y /(L) If so, List: SDP's Revised 7/1/2011 Page 3 of i ! I ; I Is'-2 1/2" 17'-!!" -15'112 1/2"- -- o O O O _ T T_ m II nn T T m — r T T n m I! �I O -26-4` II' o i n I� I T n rn CD v cn i n WX o O ch ! _ m ! 4'-2" 17'-5 1/2" 5' o T T C -' '!9'-01/2' G'-21/2' V m y T N CDO I� D p Z T m T _ I_ j M o i i t J1 Q cD m f v N C' ) m I A u p / i // � �� _ -� J Cl) D D �/ Q 5' l m = oZz.= - l �.b7. = N O• — � I I I I