HomeMy WebLinkAboutCLE201600127 Application 2016-06-09z N)
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A.ppiicatimn for Zoning Clearance "
CLE # ,-�-i
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Jtit�50 Date: 0A4 0 Cs 1s
Receipt # I [5 CL61 Lly Staff. -
PARCEL INFORMATION iN�I 1
Tax Map and parcel; 061 WO-03-00-019A0 Eusting Zonirxg� Q Q ;Y?C l i liz
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Parcel Owner: Albemarle Place EAAP, LLC
Parcel Address: 724944tissot WA Ave,•seite484 City 4k4heStia StateA`19-- 11 Zip 20W
(include strife or floor) le
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PRIMARY CONTACT
Who should we call/write concerning this project? Ryan Lore
Address: 7200 Wisconsin Ave City Bethesda State MD Zip 20814
Office Phone. i 30t l 347-3736 Ceti # Fax # L3q l) $52-3585 E-mail riorey@e ens.com
APPLICANT INFORMATION
Check any that apply: Change of ownerslutp Change of use Change of name X New business
Business Name/Type: Qdoba Mexican Eats
Previous Business: on this site None
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:
Fast tyasaad �inin^
•This Clearance will only be valid on the parcel for which it is approved. If you change, tntersify or move the use to a new location, a new Zoning
Clearance will be v quircd.
I hereby certify that I awn or hav c s ission to use the space indicated on this application. I also certify that the information provided
is true and accurate t t~ I have read the conditions of approval, and I understand them, and that 1 will abide by them:
Signature Printed.
OVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
Backflow prevention device and/or current test data needed for This site. Contact ACSA, 977-4511, xl I7
[ )No physical site inspection has been dome 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
Zoning Official
Other Official
Date. C {,
Date b ol"°
(n -
Date ~ )(
County of Atoemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax; (434) 977,4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Yl�Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y_)/ N
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 well r pu ater?
If private well, provide H6WLDgpdrtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app91
Is parcel on septic or ttsewe ?
Y/N
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 Pennit.
Permit # lo14 -P-0 A
Zoning to complete the followinn:
Reviewer to complete the following:
Square footage of Use: b
YIN j
ermitted as: 4i
Under Section: A��
Supplementary regulations section:
yParking formula: ! J/
//orb
Required spaces:
Y/
It be verified in the field:
Inspector
Notes:
Date:
Viola 'ons:
Y / CT
If so, List:
ffers:
go/ N
If so, List:
_
Y/Ye: Vari
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3