HomeMy WebLinkAboutCLE201500146 Application 2015-08-03Application for ZoninClearance T �
CLE # 2 O 1 � J 11
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 1.04 Date:
Receipt # � (`j Q (r, ,' I Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0-75?0 b _C20-001055 Aja Existing Zoning P-
Parcel Owner: Lv-1 o P— L L C -
Parcel Address: ��� ! �+ n �City%StateKI
(include -suite -or iYoor)
PRIMARY CONTACT
Who should we call/write concerning this project? j JorZ
Address :1 R
�S 06Y -C4 ,
City ��/ ��'�-%� State
Office Phone: 79- Cell Cell '
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: row ter- fJ�cSvc_ic�{�s��;
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available�i king spaces, number of
vehicles, a�% d any, additional _i[nform)atio�n that you can provide.
Ev�-,e par
GcvtcXG�r�foc 1 1 LSC �[l !?iG w�, A14t 'n"
�Occ t? 'GCi/J111 saT r3r /Z[ts ry
*This Clearance will only be valid on the parcel for which it is approved If you change, intensify or move the use to anew 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 actor e e beof my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature 2 �zc rinted
APPROVAL INFORMATION
rjC] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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
Zoning Official
Other Official
Date
Date %
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 /(D
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/PWill ere 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 thatapplies
Is parcel on private well or 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 ublic sewer
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YO/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # L ,
mooning to complete the
Violations:
Y/
If so, ist:
Valiance:
Y/l
If so, List:
Clearances:
Reviewer to complete the following:
Square footage of Use: [ 9 ks 5 I F,
() / N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula,
Required spaces:
Y/N
Items to be verified in the field:
Inspector: Date:
Notes:
Proffers:
vY/N
If so, List:
�3 3
SP's:
Y/N
If so, List:
SDP's
Revised 7/1/2011 Page 3 of 3
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NOTES:
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STUDS UNLESS
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NOTED.
2. ALL DIMENSIONS
ARE TO FACE OF
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NOTED
OTHERWISE.
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NOTES:
1. ALL WALLS ARE
2x4 @ 16" O.C.
STUDS UNLESS
OTHERWISE
NOTED.
2. ALL DIMENSIONS
ARE TO FACE OF
STUD UNLESS
NOTED
OTHERWISE.