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HomeMy WebLinkAboutCLE201600054 Application 2016-03-14Application for Zoning Clearance CLE # ,,)6 /6 00,�, 6F(l i7�, pil OFFICE USE 07Y PLEASE REVIEW ALL 3 SHEETS Check# 3 Date: Receipt # /D 3 q 1 5 Staff: PARCEL INFORMATION 11� Tax Map and Parcel: Q E7 Existing Zoning I7 Parcel Owner: Parcel Address-,_q : Q a x 63 q G -!"C ty ,P1 I ` n [(,� State ' zip (include suite or floor) PRIMARY CONTACT Who should we call/write concerning,this project? ED �A_ Address :� Vii/\ City {%� R State _ V�{� Zip���! fa't� Office Phone: L -.1313 _ Cell # 7i'� ' ��,r Fax # E-mail AAkiSyic,-_a''0 t'rG APPLICANT INFORMATION Check any that apply: Change of owners(hii,p� n `. Change of use Change a name New business Business Name/Type: � � \`'-��, �ICA Previous Business on this site '%Q t Describe the proposed business including use, number of employees number of shifts, available parking number of vehicles, and any additional information that you can provide: �WLO Fj *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 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 4, G Printed 19-e A4e6vn 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 J Date _-Ut o J� i [_ Zoning Official '�✓ Date __30) d Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 V'/ Revised 11/1/2015 Page 2 of 3 Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet.' YIN �� WiII there be food preparation? If so, give applicant a Health Department form. �r 5�ts°viae Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies N l� Is parcel on private well or public 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 )J/J+ Is parcel on septic or public sewer? V/ N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YAD ME—there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to cominlete the followin : Reviewer to complete the following: Square footage of Use: 0 Ot / N �j (� Permitted as: ,�1t191 /`t--�cX 4r L& Under Section: Z 0�. Z. Supplementary regulations section: Parking formula: ke—A -� Required spaces: sL Y/N Items to be verified in the field: Inspector: Notes: Date: Violations: / I f so, ist: Proff . Y / If so, st: Vari ce: Y Ifs 1st: SP's• Y/O If so, List: Clearances: SDP's Revised 11/1/2015 Page 3 bf 3 0)} � (�- f / § \ : \ § ` . IN \ } { \ , � / � \ \ � k } ■ $ ° � \ _ � @ � k $ � � � \ � � \ , \ � © � Ce) § , � .