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HomeMy WebLinkAboutCLE201500240 Application 2015-11-19Application %r Zoni.n Clearance CLE # C7 � `"' — S -A p OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # 1xt o Date- 1 � I 1 S Receipt # o I t, 0 staff .f PARCEL INFORMATION Tax Map and Parcel: 79— J G ,4 Existing Zoning Parcel Owner: I o EesA L A? A" ' ., ru Parcel Address: �� -Cc', i; Cid, �_ � State (include suite or floor) 5 ° PRIMARY CONTACT Who should we call/write concerning this project? e Address :10 city r State Office Phone: E-mail �3c� la4 APPLICANT INFORMATION Cheek any that apply: Change of ownership Change of use Business Name/Type: lid Previous Business on this Zip of name New business Describe the proposed business including use, number of employees, number of vehicles, and any additional information that you can provide: y p ' available parking pa number of +/cot ^{ °,5 Sit 'T^ *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 Zoni�w Clearance will be regained. I hereby certify that I own or have the ovmees 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 understand them, and that I will abide by them. Signature Priuted s11: 014 A.) tK, X EL % C A> APPROVAL INFORMATION xf 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 site plan. of compliance with the existing [ I This site complies with the site plan as of this date. Notes: Building Official Date R — Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5932 Fax: (434) 972-4126 Revised 7/1/2011 Page 2 of 3 Intake to complete the following: Y/©N Is use in LI, M or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y / Will 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 that applies Is parcel on private well o public water? If private well, provide H eparhnent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap Iies Is parcel on septic o pu c sewer? YIN Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper Y/ ) Will there be any new construction or renovations? If so, obtain the proper permit. Permit # Coning to Violations Y /!N1 If so`, the Reviewer to complete the following: Square footage of Use: 1200 S. P/ N ermitted as: Under Section: Z-%. 2 , Supplementary regulations section: Parking formula: - �va Required spaces: YI items o be verified in the field: Inspector: Notes: Pro If sKst: Va' e: SP's: Y/ Y/ If so, List: if so, List: Qearances: SDP's Date: Revised 7/1/2011 Page 3 of LY CR 3'-5y2l' Cl) CJ) 0 caC4 m 0 C5 0 C:) M -n ($)-a tom o m ;D Ln > m 0 m i 16 i . .... ..... ate 40- (09 cz 00 --o L CL >