HomeMy WebLinkAboutCLE201600077 Application 2016-04-05Application for Zoning Clearance
CLE # a d [o ` T)
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O
Check # Date:
Receipt # - Staff.
PARCEL INFORMATION OGI-6 " fd1..—0 -MOAO (,
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Tax Map and Parcel; • Existing Zoning C l •�iYY� ryLQ_
Parcel Owner:_P—OW A, _IPP r E es-'_ LUC
Parcel Address; 'Z i 23 C.YY�-�^ City (Alf 1i WA State VA Zip 22clol
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? ulz
Address : 15 t- L2 City �)J JJL� State V A Zip 21
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Office Phone: '3� Z��el1 #�'�—�Si�O� Fax # NI& E-mail e hY06M
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 3 1. L1za1L-rMrn'Ta'V.'(S'
Previous Business on this site,�YV �gyL('�1i1 I�.YN V1QY1-_
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: 6n -�
to �. 611
"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 Printed l OLY17�-- MC,G0JA,,-x h T
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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 ' a
t
/�,
Zoning Official Date �/�AA„,.--
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-M2 Fax: (434) 972-4126
TO
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Revised 11/02/2015 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 (CLR) packet.
Y /b
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 that applies,
Is parcel on private w or pnbff ter?
If private well, provide�artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies --
Is parcel on septic or p lic s
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there 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: lv
6/N
Permitted as: _�n�;�-��L.1��11 ; L- 7rA ri7 y�
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: ,
3
Y / N - - ---
Items to be verified in the field:
Inspector • Date:
Notes:
Vio tions:
Y /<W
If so, List:
Pro
Y/
If so, List:
Varia ce:
Y/61
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
� 22
Revised 11/1/2015 Page 3 of
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