HomeMy WebLinkAboutCLE201500230 Application 2015-12-07Application for Zoning Clearance
CLE # l S T30
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE OT%V
Check# 10tvA Date: I 5 lS
Receipt # Staff:
PARCEL INFORMATION Co -t •ta-• L" a .1 C -5a
Tax Map and Parcel: ExistingZoning r
Parcel Owner: FM ?0----A
W ecs6,i2__
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Parcel Address: S35 "S+ -Ce "J(el 196 J Ji City [ knA644c"i State VA Zipay,761
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? -rt�4 Jai a ss rYl�tl� _
Address: -14,2a Sa"aws Pw- !�• ,4 a. City CLLAI.o�sJd tate Zipoz90 /
Office Phone: ( a93 alCd* Cell !f A1tQ@4'ax #V,4 SE-maiI a-�jp
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ✓ New business
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Business Name/Type: i l pawl' Z/1C. �"' e ria Sol
00"&fe.s c w4 a{ *kgk *"■,a e, e) ,rdscph- �7ad.dJq Nt a
Previous Business on this site �� ,a(d Ad CI.A aT 1. /4e. is dru.s-de -*4 gb
Coe per* on•
Describe the proposed business. including use, number of employees, number of shifts, available parkinspaces, number of
vehicles, and any additional information that you can provide: s r
4dl4•. dmAAsrs G.T Als lGCakspa- One, AcLA F•„n6M t to h . ly-
*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, anew 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. 1 also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature , W( `TC�Printed (. ,rtd� lK i�a:�~%4 7r e.Ls•e.�
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xI 17.
[ ] 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
Zoning Official Date_: alkf—o—� Z4�
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 11/02/2015 Page 2 of
Intake to complete the following:
Y
Is bin Ll, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Will`{�eri
e 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 we�epartment
r public water?
If private well, provide form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies z.
Is parcel on septic or p
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: Y– b a
YIN
Permitted as: d i 1 y U5Q,"
Under Section: ;7-2 , 2 .j
Supplementary regulations section:
Parking formula: <;�- 64
Required spaces:
YIN
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/�
If so, ist:
Pros:
Y/(N
If so, est:
Varian e:
Y I E
If so, ist:
SP's:
Y 1
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page of
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