HomeMy WebLinkAboutCLE201600123 Application 2016-06-08Application for Zoning Clearance
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CLE # . 62- d�
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OFFICE uSE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # V Date•
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0 Q— 0 0 --- Q 0 — O Existing Zoning
Parcel Owner:— JWX0i2 0EIRICEP—J k k 4 4C. —
Parcel Address: 0, %4 POA 101 aw City Y State Zip 2� y
(include suite or floor)
PRIMARY CONTACT
y
Who should we call/write concerning this project? kmv
Address: S:Uu k�t_Stt. Wiz. City baf Ax State VA Zip
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Office Phone: U Cell # 2 x # E-mail cAlT.— n/iF71ey�tlo
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 107MA00 11C D86 S' P110 AV-07) 1"AeKq?J
Previous Business on this site
Describe the proposed business Including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and a additional ' formation that you can provide: I
ri ` P 912
*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 fabntionf7knew 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 m knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature � alL PrintedMq—
OVAL lNFORMAT N
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roved as proposed [ ]Approved with conditions [ ]Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ ] 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
Zoning Official Date tom I'Llia
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/0N
Is use in LI, HI or PDIP zoning? if so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will e�T
re 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 orl ublic water?
If private well, provide Heal ent form
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic o ublic�sewer?
Y /0T
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y Q
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: :Ztt
00/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y /'0
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/O
If so, List:
P offers:
/N
so, List: Oq
Va ce:
Y/
If so, List:
SP's:
Y/1,1J
If so, ist:V Y/st:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of