HomeMy WebLinkAboutCLE201500151 Application 2015-08-03Application for honing Clearance � ups raj
CLE # 'cA0 \ S — 1 S l
PLEASE REVIENV ALL 3 SIiEE`I'S
OI'hICI: USE
Chech it C-;;•':6'
Receipt tt -LU (b`-')�_ Staff: _'6C5L'[;�
PARCEL INT+ORAIATION ( f L_r
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Tax Map and Parcel: Existing Zoning_.
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Parcel Owncr:
Parcel Address: 3'y�C. n �/ e�, (t City `� �d (' ��r�%State `/ -�— Zip2f6(
(include suite or• floor) CJI1^
PRIMARY CONTACT
Who should we call/write this
concerning project?--t_=`f��N�
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Address: a ���� � SUI����°City C,�'t��(�_ State Zip
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Office Phone: ) V Cell Il ?V Q' Y/a/ Fax Y 17 -mail
APPLICANT INFORMATION
Check any that apply: Change of�ownership Change of use Change of name_ C�New business
Business Name/Type: �l � ,-V
p
Previous Business on this site. I� kv?il" 1'
/{G`1,-- iood WFIy / <b (- oL
Describe the proposed business including use, number of employees, number of sh),tts, .gvaHable parking spacnumber-op
information
vehicles, and any additional that y,p u can prq� jde:
OF
"This Clearance will only be valid on the parcel for which it is approved. lf)'ou change, intensify or n -rove the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that 1 own or have the ONVIM's permission to use the space indicated on this application. 1 also certify that the information provided
is true and accural to the best of my owledge. 1 have read the conditions of approval. and II understand them, and that I will abide by them.
Signature l r "���n
/` Printed 1,.,rP.�
APPROVAL INITORAIATION�_� zojj_-3/
Approved as proposed Approved with conditions-✓ I ] Denied
I ] Backflow prevention device and/or current test data needed for this site. Contact ACSA. 977-4511. x 1 17.
.I No physical site inspection has been done for this clearance. ThereRve. it is not a determination of compliance with the existing
site plan.
I 17 his site complies with the site plan as of this date.
Notes:
c --
Building Official Date
Zoning Official Date r5
Other Official Date
(:ounty ofAlbenuirle Department of Community Development
401 Mclntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised I/ I /20 1 1 Page 2 of 3
C�
-j fill�da to complelc the follom ing:
Is us rn 1..1. I-II or PDII'roning?- Ifso, give applicant a Certified
fingineer's Report (Clot) packet.
), / V
Will then be Brod preparation?
IfSo, give applicant a I lealth Department ('corm.
Zoning review can not begin until we receive approval from I Iealth
Dept. FAX DA'Z'E
Circle the one that applies -
is parcel on private well o�ptrliltc•r ,,,
If private well, provide nt lbrm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE;
Circle the one that app�Icsewerl
Is parcel on septic o
Y/N
Will )-ou be putting up a new sign of ani, kind . ?J f so. obtain proper
Sign permit. -
Permit #
Y /c � PP1y
Will there be any new construction or renovations, /
If so, obtain the proper Permit.
Permit # _ -- ttofq(,�4
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Zonittg to complete the following:
Revici er to complete the following:
Square kwtaee of Use: lw6
Permitted as: t G i, C7�
Under Section: Zy• Z,/ — -55P' 'Zd%l"-'✓ /
Supplementary regulations section:
Parking formula:
zJo
Required spaces:
Items to be verified in the field:
Inspector : Date:
Notes:
101aq,khons:
I f so. List:
Ik'offers:
jvSo, List:
lt'iaRCC:
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Ifso, List:
SP,s:
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lfso.I.ist:
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Clearances: —
SDP's
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