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HomeMy WebLinkAboutCLE201600002 Application 2016-01-07Application for Zoning Clearance CLE # - •.i%" OFFICE VIE QNLY I� ❑ Zoning Clearance = Check #Date: PLEASE REVIEW ALL 3 SHEETS Receipt #WIStaff: PARCEL INFORMAT OST Tax Map and Parcel: � / Existing Zonin ©ill Parcel Owner: �y Parcel Address: City C fhGL�C �� e ZipZq� U (include suite or floor) PRIMARY CONTACT'~` Who should we call/write concerning this project? J 5; Cx"rr S Address: ! .a.✓ c" C City �/S ESc--i C k- State Vjd Zip Office Phone: ffis _d Cell # Fax # E-mail(0C7'"fA• C APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: AT 7A/ i_S BUS/' e —S S !�S .S7, 7,e -C-, 7f/C-r-,2, Previous Business on this site ee Cc 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: cg - O *'['his Clearance will only be valid on the parcel for which itis approved. Iffou change, intensify or move the use to anew location, a new Zoning Clearance will be required. I hereby certify that 1 own or have the owner's ennission to use the space indicated on this application. l also certify that the information provided is true and accurate tot est I . I have read the conditions of approval. and i understand them, and that i will abide b} them. I� A— Signature Printed -a% APPRO INFORMATION Appr ed as proposed [ } Approved with conditions [ ] Denied ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x] 19. [ } No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. I I This site complies with the site plan as of this date. Notes: Building Official Date } J r_/ 11 Zoning Official Other Official 'l �j✓ Date 14.1 t 14-01"0 Date .: County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (43 Reg ised 04/28/08 pale 2 of 3 Intake to complete the following: Y l 6 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineers Report (CER) packet. Y /t Will there 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 opublic w er? If private well, provide Hea ment form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE Circle the one that appl' Is parcel on septic or M sewe ? YIN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit 4 Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit 4 7nniirnrs fn rmmlnlPfP fl.P fnllnwino- Reviewer to complete the following: Square footage of Use: �- d/N Permitted as: ce. k:j e. - �'I- . -2- I Under Section: Supplementary regulations section: Parking formula: Required spaces: -� YIN Items to be verified in the field: Inspector: Date: Notes: Viol ions: Y /6) If so, ist: Proff rs: Y / If so, ist: Variance: j Y / 6 I If so, List: SP's: O/N I so, List: 4 _f 7 Clearances: SDP's 6 — Revised 04/28/08 Page 3 of 1 office CIO Sketch of 103-A Free Bridge Lane, Charlottesville, VA 22911 Main Floor (Ground Level) appoximataly 1 375 -square feat treatrnarrtI treatment m rooroom waiting area closet bathroom x-ray exam therapy room reception area fi room -7 H is