HomeMy WebLinkAboutCLE201600124 Application 2016-06-23Application for Zoning Clearance
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CLE # 1.� r. .
Idt�N
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff:
PARCEL INFORMATION &"1
Tax Map and Parcel: 01-7 00 - 00 - Od •
Corte far -� ar � d o h �317, arm
Parcel Owner: 0;11e-,e,5+ t.iL (Cl6r D6iirG r"" ' % �,a,. -itnt r1k.J 1, N.
Parcel Address:'JZ WWI .--* 1 d"Z City D-(w`O pul [QState VA
(include suite or floor)
PRIMARY CONTACT���.,__�y,���
Who should we call/write concerning this project? ✓1 0n `-"'Air "e
Address : Z M ilG� et& City (.WodolAsU 1 le, State VA Zip2 t62
Office Phone: L) Celt# Fax # ^ E-mail S1 c., l 2) 'l.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: m �A - i^c-
Previous Business on this site Ef uC- cmd- Ma�-�ar _
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 a e to the best" knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Printed 5kLWA
[Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] 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
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official
Date
Zoning Official
Date
Other OfficialX-AJDate
ORc3 � ko
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/1/2015 Page 2 of 3
Inta a to complete the following:
Y N
Is us 'n LI, HI or PDIP zoning? If so, give applicant a Certified
Fngineer's Report (CER) packet,
YIN
`, ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not be in until le receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or blic wat
If private well, provide Health partment 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 p is sewer?
YIN
Will you be putting up a new sign of any kind? If so, obb'ttain proper
Sign permit, wm y
Permit # �,(,— T� P'Y
YIN
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: If
2r1 N GV'Q—"fi
mitted as:
Under Section:
Supplementary regulations section: .
Parking formula:
Violations:
YIN
If so, List:
offers:
YIN
f so, List:
*�
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's��,
Revised 11/1/2015 Page 3 of 3
I �? I Hv-t�
06/23/2018 10:56 9724310
95880 P.001/002
Application for L
nf g Iearance
CLE #
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Chuck # Dote:
Receipt 0 Stab.
PARCEL INFORMATION l
Tax Map and Parcel. W - GoOd .
Cat,+ fW "rumao err r// .
Parcel Owner: Ai fl eAm h+b L Z, I t a �11aC� I rs f %b ji
Parcel Addroo- d-L City' u7(.Stata�^
(include suite or floor)
M- MARY CONTACT
Who should we call/write concerning this project"
Address : (002- M e..0 ftry —city tat 1 le, Stake VA
Office Phone: (_ ) Ce1F Fax tl E-mail S"I r . LO:i
TION
Cbeelt any Ast a lry: Chstsge of awnettahip Change oiuse C1>ratt�e of name ricrac basieesa
Business Nowe/Type. ' %10J LdW k/1 ? _.__ F
Previous Business on this alte na m9fiDdr
Describe the proposed business iveluding use, number of cmployeet,
vehicles, Rh d any ,s dWona! Information tbat ore can provide: An
1I--114
'ThisCl eel}bid414 �tis.ppxoved, Ifyou
Clearmee;e will he rcquirrd.
number of shhtts, available parking sptac m, number of
ft"Am+ r#. I Zara - an... AAA. _C.4
or MOO the ltse to a new location. a new
1 betaby ratify that I own or have the ownree permission to use the space indicated oo rhls applicatlon. I also certify 0tu The informagon provided
is true ww WARM to the bcs)" knowledge, I have read tho conditions of approval, and I understand them, and that r will abide by lhtr&
printed � j'1 A1'1 F1P"r �
( ] Approved its proposed [ ] Approved with aanditians [ I Draied
[ ) i3ock(low prevention device and/or current test data needed for this site. Contact ACSA, 07-4511, x117.
[ ) No physical sire inspection hos been don for this clearance. Therzfore, it is not a dotormination of comp] iancc with the existing
She plan.
( J This site complies with the site plan as of This dots,
Notes:
BuildingOiNcia[ Date. ! «br-�
Zoning Official ,_ Q- . /pate
Other OMelai Ila YL . J Date I &:P
S/ "]L� I'M 1 7 1 )
ounty of marle Departaoent of Co euty nevelopmdt
40I McIntire Road Charlottto011e, VA 22902 Voice, ( 4) 296-5832 Fox: (434) 972-4I26
Revised 11/1/2015 Pagc 2 of3
08/23/2016 10:57 9724310
#5890 P.002/002
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"ddpated opeift dsde: Seats expludt! t �
Tno of MMa-PIMM do* +u tbat apple Puffienwe Fast Fookzam d CWryoat Cater
Sabna-Public as Piivalu Dayme., OrnW Homo Cftocay 9tM IuWM CM Tj+pe
N=bM8 � ApaiosI a� CAI &osItfiast M6biI&*9h c wt Seaaaaaal Type
raforaa do to be nbmitted to Xavbmnmemtal' Hesllb DupartmGrt
Mcmea F.goupMCM =abWrd on; fIOO r plan drawn to scalp
Plan nviaw ■ PPuCxtiom .Pay plain, reviiew aed smanal permit fws
Reuel pecamt apffiaff1o. EquipmM sp=dwutraa ubom and ptamb
Type of Watw Soppy►: Fublie Privese
1P7c of Swage System:
Ekvirmmeat
Approved by:
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N=WM[MiW? M NO
Appruval Ante:
Azaved: OM 13140
-AMMM ►ed: n YPS n wn nate.
JUN 2 D 2016
C: ha rlottesvl II elA I bemar'le
Health pp��,,c�oprtment,
HY: TWtMl ffT'
Facility Name: PRON 6 J1t443AN
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