HomeMy WebLinkAboutCLE201600020 Application 2016-02-09Application for Zoning Clearance
CLE # . di — act
OFFICE iJSE ONLY
PLEASE REVIEW ALL 3 SHEETS Check# 6 3�'a ]pate:
Receipt # — Staff: E
PARCEL INFORMATION
Tax Map and Parcel: 02902 -00 -00 - 03-1 A� Existing
Parcel Owner:_1. ipSQy�-t Ur___ _ j
ParcelAddress:I, `C, 01 ; &.\l &)D� City �tk� `Q State V A zip��
(include suite or floor)
PRIMARY CONTACT T
Who should we call/write concerning this project?
Address : L� kDO (Ill D+1 City _ &V,&k State Y zip Qa
Office Phone: 1-+ 019 CeR #_(z3 ,lQ4.`4Fax # :Tta • �31x:3153 E-mail
APPLICANT INFORMATION
Check any that apply:
Change of ownership
Change of use
Change of nameNew
business
Business rame!Type: `
, l fi �- Cobu/-
ALJo�1
Previous Business on this
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: yr or}Al2np_ _1VV14tz.: c�,pvv nc hitc"nree LLo�
*This Clearance will only be valid on the parcel for which it is
Clearance will be required,
you change, intensify or move the use to a new location, a new Zoning
I hereby certify that I own or -ave the owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the b of my knowledge, 1 have read the conditions of approval, and I understand them, and that I will abide by them,
Signature PrintedIV
11M I.LTZ� l I.I,VI ��
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; 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) 972-4125
Revised 11/02/20I5 Page 2 of 3
Intake to complete the following:
Y/&
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / thl
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 or p lib c aterr.
If private well, provide Health Department fonn.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or up blit s ?
Y%N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y i N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit ft
DninE to complete the tollowlnif:
Violations:
Y I
If soPist:
Variance:
YIN
If so, List:
Clearances:
Reviewer to complete the following:
Square footage of Use: _ -` �� ()
(9/ N ,y
Permitted as:
Under Section: 7
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector • tate:
Notes:
Revisbd 11/1/2015 Page of
14
LUXURICU$ OfI1 Es
FOR MORE Mason Graham, CCIM
INFORMATION Vice President
PLEASE 434.284.4010 www.cbre.com/charlottesville
CONTACT mason.Oraha+ii@cbre.com
CBRE I Charlottesville 1 314 Easi Water 5treei I Charlottesville, VA 22902
0 2013 Cli Richard Ellis of Virginia, Inc. This information has been obtained from sources believed reliable
We have not verified it End make no guarantee, warranty or representation about it. Any projections,
opinions, assumptions or ;estimates used are for example only and do not represent the current or future
performance of the propoity, You and your advisors should conduct a careful, independent Investigation of
the property to determine to your satisfaction the suitability of the property for your needs.
KITCHENETTE
CBRE I Charlo#tesville
Part of the CBRE affiliate network