HomeMy WebLinkAboutCLE201600082 Application 2016-04-09Application for Zoning Clearance
CLE # dol to— 29
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OFFICE USE ONLY !!
PLEASE REVIEW ALL 3 SHEETS Check # 11 O ( Date: y R911 10
Receipt # _� p'�s$ (t, � Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0-7 00 b 00 - 00 A7 Existing Zoning.
Parcel Owner: L-aAnp, L,LC-
Parcel Address: VILE ?'Ai 6 fl% City` rde/ S� F t� State �� Zip
(include suite or floor)
PRIMARY CONTACT �o-1
Who should we call/write concerning this project? St
- N I �2 vn
Address: l V- k vtct �r r`v� City State Zip ';Z257//
Office Phone: (J%P{) �29-81 / Cell # 9,,/, Fax # - 3 5 /0 E-mail Skv'-cu x;ala"J
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ►%New business
BusinessName/Type; eL V V rLE L
Previous Business on this site
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: CJr-
*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 accura to the est of my knowl'eddgg�e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature _ I 1 Printed vv, , 7VI
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x117,
[ ] No physical site inspection has been doyze'for this clearance. Therefore, it is not a determination of compliance with the existing
site plan. 7
[ ] This site complies with the site plan a& of this date.
Notes
Building Official Date Lf IL i,
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) 9724126
Revised 11/02/2015 Page 2 of 3
CpOA,
Intake to complete the following:
Reviewer to complete the following:
Y /@ Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. O/ N
Y /O Permitted as: A � � f�� a � r,!
Will there be food preparation? Under Section: _:L5- A
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 private well or blic 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 or u 'c slb era`
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper I
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# Eao10 -Oo57Y Ae-
Zoning to complete the following:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol ons:
Y/
If so, ist:
P offers:
/N
If so, List:
Varia
Y/1� e: -
If so, List:
SP's:
y
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
INTRAVENE (SUITE 201)
OPTION A-3
MARCH 8, 2016
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