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HomeMy WebLinkAboutCLE201600026 Application 2016-02-12Application for Zoning Clearance &" ��,,,- .,.,�, ,, CLE I PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # 1©4''1 Date: ' 9-�1D/fes Receipt # 0 3Staff: PARCEL INFORMATION Tax Map and Parcel: Existing Zoning �i t Parcel Owner:t��7�C^ 1 �+�c- �5 t/ f iy t� Ct�-�e,cy� S " Parcel Address; � 7City�% z- State Z -,4'- Zip.t 2�%/ J , �dIMh�u7_16-7—City- (include (include suite or floor) PRIMARY CONTACT ,, �� r Who e Ylkc �ay, should we call/write cone ning this project? .. 1 C°C' L Address: t IS- 4, �"�cw City e t Al.. State Zip ?2r;11 Office Phone: rt) 97-?Iefl Cell # C6-2 48 Fax # E-mailt- APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: V'r FQi rl i F`a i h '� i c5j _ Previous Business on this site_ -R ?o- &i -n— No -P.,; [.:i rkcd ; c 9 n le_ Describe the proposed business including use, number of empl"�esbeJ of shifts available parking spaces, number of vehicles, d any additional information that you can provide�h%c- eu�s rk-i= *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 Zoning Clearance will be required. I hereby certify t 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 accu a est of my knowledge. I have re nditions of approval, and I understand them, and that IJwill abide by them. Signature �F L+� Printed__�nt fl 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 Date. ti Zoning Official / Date ?� 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 3 Intake to complete the following: Reviewer to complete the following: Y /@l Square footage of Use:z^� S ' Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. / N Oamiitted as: _ _ Y /© Will there be food preparation? Under Section: If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE Circle the one that applies Is parcel on(pn�ate well or plc water?) If private well, provide 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 septic o u lic sewer Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y Q Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonine to complete the followine: Parking formula: 7"> a ij� Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Viola ns: Y11 If so, List: Proffe s: Y1 If so, ist: Vara ce: Y/ If so, ist: SP's Y/ If so, List: Clearances: SDP's p a . Revised 11/1/2015 Page 3 of Wwo"Oural Pfowtsvwwag ProputAkmtdl wcvuty drxAI03 South Pantaps Drivey1035PDFbmjans.dwg, 12/42015 7:31:37 AM f -I In CWNTER - TOP cn > rn ifI m Y-7 m ,X V-2�'t m 3K -n CD N)(D =3 Y-7 m CD N)(D =3 < (D W n CID