HomeMy WebLinkAboutCLE201600108 Application 2016-06-09L,
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AppUcation for Zonin Clearance
PLEASE REVIEW ALL 3 SHEETS � Check # Date.
Receipt# _/+7 t1� Staff.
PARCEL INFORMATION
Tax Map and Parcel; —ri rj___Ce I_A/ Existing Zoning -
Parcel Owner: A l f1,.�.,e m r I E P I of EA6 P. UL w
Parcel Address: L eel n)� N%�'_ city �4t" � b4e' ,16tate Vo_ Zip �� b
(include suite or floor) SA t t7 .
P MAR CONTACT
Who should the eall/wrfte concerning this project?
Address :(,+3_CityIM QState Zip 2"l
Office Poona: t t t )- '-UilJ L Ceti # UI {aidrax it R-malt � ' [D��' t1�!•�aSi>�t+i -
AP] PLICANT INFORMATION I
Cheek any that
4f
o#use - Ghad>te of rtnrrtc
__.- Ncw businera
Businen Narne/Type- -___ MI :5ts � 2sa E., t.A t w.dna '+
Previous Business on this site &Vn2t,
Describe the proposed business including use, number of employees$ a nber ofs#ifts, avaflalz1 stung spaces nu, mbe�-
vehicles, and any additional information that you can provide: ,' . �_
�p Sh► Lea ,�p�._._..__f�t�i�.t��'���-�� .g - , ._�...
"This Clearance will only be vial id on the parcel I'nr which it is approved. tryou change, intennfj or move the use co d new location, a new Zoning
Clearance will be required.
I hereby aertify that! own or have the owners permission to use the space indicated an Us applieavoo 1 also certify Bret the wiermation Provided
is true and acaura[e,"e best of my knowledge. [ have read the conditions of approval, and l understand (Item, and that 1 will abide by (ham.
Signature - -Z<r7"r r J Printed- r 6k.i�2iru a4?„
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ 3 Denied
1 Backilow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 11
( ] No physical site inspection has been done for this elearance. Therefore, it is not a determination of camphanee with the existing
site plan,
[ j This site complies with the site plan as of this date.
Notes:
Building OfYicia1 •;
Date t ( t-
� z
Zoning official Date
Other Official n _�.. w _ _.. Date
County of A lbetnarie Department of Community Development
401 McIntire Road Charlottesville. "VA 22902 Voice: (434) 296-5832 Fax., (434) 972-4126
Revised 11/1/2015 Page 2 at 3
Intake to complete the following:
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Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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WiII there be food preparation?
If so, give applicant a Health Depamment form.
Zoning review can not begin urltil we receive approval from Health
Dept, FAX DATE ; Zv L
Circle the one that applies
Is parcel on private well p ater?
If private well, provide H nt 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 Ou is
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Will you be putting up a new sign of any kind?
Sign permit,
Permit #
If so, obtain proper 1
O/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # ;7-0 / �y
Goni!ne to complete the iollowiint?:
Violations:
Y l
If so, ist:
Var ce:
Yl�
If so, List:
Clearances:
Reviewer to complete the following:
Square footage of Use:.. 3,3 -2' 6
q/N
ermined as: eogiAa,
Under Section: A%�. IAC'e. C . U•�-
Supplementary regulations section:
Parking formula:
Required spaces:
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Items to be verified in the field;
Inspector • Date:
Rotes:
ffers:
o, List:
7�tf4 �oa�_ 7
2a
Ys
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If so, List:
Revised 1 I/l/2015 Page 3 bf 3