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HomeMy WebLinkAboutCLE201600039 Application 2016-02-24Application for Zoning Clearance CLE # 40 OFFICE U E ONLY PLEASE REVIEW ALL 3 SHEETS Check # 5C aZ ? Receipt #.103,90 7 Staff: PARCEL INFORMATION Tax Map and Parcel: -6 —C, -00 -01A60 Existing Zoning Parcel Owner: UV A fWv1J &-tl bye, SU I � •-- Parcel Address:_I �lNOSaj t t� ujyil-c I 12I City C kA,a/ {o }icA V ILL State V Ar Zipz?,10 � (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? WaAjfojV e4— Address • 4 0 tZStC4—1'' City d%AvWS V1 N- .State J)A_ _Zip 721r- j Office Phone: (11 IJ l i q `6854 Cell # SA MZ Fax # E-mail APPLICANT INFORMATION e & Ivh' Ie -,I Check any that apply: Change of ownership Change of use Chance of name V New business Business NamelType: LE Anvll C yw- I or s PUC Previous Business on this site %1 VAIdL&Yn 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: L J Ya E d . l Ltr1 S%C%V; (,2 S 6V 4a in Inn /AA.AII-e%^.^iv.. r- -t%in.-z.1 I-A—I. f' _Q-C.n.__ _J,• _ *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 that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and faccurate to tthe. bestof my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them Signature'_' "`�-�► �'°� ✓ Printed iG[ tQ (j �?A Ve4,-- 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 Z Zl-'A t 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: Y I® Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wi 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 tub ' ater? If private well, provide Heaepartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appy Is parcel on septic ore r ubli sewer? Y `O Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YN `! Wi ere 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: c3 &/N Permitted as: Under Section: Supplementary regulations section: Parking formula. •L.SJ Required spaces Y I Items o be verified in the field: Inspector : Date: Notes: Violations: Y/Oi If so, List: Proffers: Y/ If so, ist: Variance: Y/g) If so, List: SP's: . Y/(9 If so, List: Clearances: SDP's Revised 11/1/2015 Page 3 of 3 EXHIBIT "A" Attached to the Lease Agreement between the UVA Foundation and Profile Z"2. , 2016. PREMISES FLOOR PLAN oA am m W 7 •. r ww ® �rJ�T la 121& -TIn Q © a `O I a n r % r Its, ® m .s ae.ry.n rr ` � serer +s.a „a, ©© m e c E3 �R r�1 w� ® rrr +® �.r 3 ' Ad -tre S5 238 Rentable Square Feet, 1 Boars Head Pointe,{ Suite 121 1150 Sf USHUC