HomeMy WebLinkAboutCLE201600042 Application 2016-04-09JI
Application for ZoningClearance
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CLE # i� — Dcz
raa
Ol~ FICE UE ONLY
PP�ARCEL
ASE REVIEW ALL 3 SHEETS Check # �9 S W Date: a-a9 "9414'
Receipt # D3 9 r! Staff:
FORMATION
Parcel:'Q(j-taCJ-037� ExistingZonin SOFA ,Z L.LC�
Parcel Address:3456 &r it (i T ;L City State Va•- Zip
(include suite or floor)
PRIMARY CONTACT ,
Who should we call/write concerning this project? C.J AEL y A5� 0.5' , I
Address :_ P+i� .Cad �O /0 City2 UJ 6 Stateys.
Q Zip
Office Phone: Cell # a%p - %dax # 'Si 9�E-mail
APPLICANT INFORMATION
Check any that apply: n,� Change of ownership Change of use Change of name ew business
Business Name/Type: M 14PAC1 S
Previous Business on this site
Describe the proposed business including use, number of employe ,number of shifts available parking spaces number of
vehicles, and any additional into oration that you can provide: TI Ootryl CA,_ 45. - M
W 3
*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 hay the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and ac at to+the b o y know dge. I h read the conditions of approval, and I understand them, and that I will abide by them.
Signature t Printed M
APPROVAL INFORMATION
Approved as proposed [ J Approved with conditions [ ] Denied
TBuilding
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
plan.This site complies with the site plan as of this date.
s-
Official Date 3
Zoning Official Date 2
Other Official _ Date
"7�_
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised l l/l/2015 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If soZ
plicant a Certified
Engineer's Report (CER) packet.
FY / N
ill there be food preparation? �
If so, give applicant a Health Department form. ✓G
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies �--
Is parcel on private weal drioublic4ater?
If private well, provide Heal Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic or bli ewer?
it N
dill you be putting up a new sign of any kind? If so, obtain oper
Sign permit. ` \ . 5 m ,off i ut f�w(� rub rMIT
Permit #
Yl
W i! ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Fy—tolations:
/ N
If so, List:
Varian e:
Y I
If so, ist:
Clearances:
Reviewer to complete the following:
Square footage of Use: j 2�
I N itPermitted as: �" {3 / �e
Under Section: ZT_•
Supplementary regulations section:
Parking formula: J3 /
Required spaces:
YI
Items to be verified in the field:
Inspector: Ixi
Notes:
Proffers:
Y ql T)
If so, ist:
SP's:
O/N
If so, List:
SDP's
_ -J
Revised I l/1/2015 Page 3 of 3
04/08/2016 14:35 4342935199 JAMES F HAMLETT PAGE 01/01
COMMONWEALTH OF VIRGE41A
DEPARTWNT OF HEALTH
CERTIFIES TROT
VA V 72r iLLC
is hereby granted a permit&&ense to operate as a
Fwt servAm. Restsummi
by the Albemarle County Health Department in accordance
with the regulations of the Board of Health,
Commonwealth of Virginia.
FACILrrYXAIY E: MICHAWS DINEIR
PHYSICAL ADDRESS: 34SO Seminole Frail
Charlottesville, VA 23911
M"LI GADDRESS. PO BOX 6010
Charlottesville, VA 22906
EXPIR,4MN DATE: April'309 2017
CONDITIONS:
Eric S. Pyers, REND'
mmentaft Health Supervisor
Please direct questions or concerns to the
Albemarle CountyHearlth Department,.
EnvironmenW Health Ser foes, (434) 972-6219.
This Permit !s NOT i'RANSFERAIMIM Freon One fndleldmi.
or Loeartlen to Another.
NO T4 4 PARCEL FOOR PLAN
v
CA
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