HomeMy WebLinkAboutCLE201600243 Application 2016-10-28Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY t _
Check # Date: J�
Receipt # Staff:
PARCEL INFORMATION YY '' '' rr,,S — 1 CJ A
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Tax Ma and Parcel:ul W —Existing
V Zoning J
LLC 0" ' C
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Parcel Owner:` 1Cj� jr�t 10 K- W
Parcel Address: Z05(3 T�OP40 51. 5� iT- F� l] City CA64n1b7;z55✓74a State Zip zZ9ai
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? /Z
Address :_ I �� riq CL I niL)A DsL City Lytju- 3 n_r_ State VA Zip ZY)X"_ -
Office Phone: Cell # 7z4-6-7g-rtpz 7 Fax # E-mail rSVa Oct @
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name XNew business
Business Name/Type: Suzar
Previous Business on this site_ :S00G" A-,JQ 13e7L-fL'
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: 30E-SC-Lvt: f;yu,Ze-4 OLa$611. Z -,7 4Aes'u�y J
oN3HIfPr, Z .56if-�3 r' ol?y
*This Clearance will only be valid on the parcel for which it is approved. Ifyou 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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed %LY.?►v/ YC,11,IX'7Z_
APPROVAL 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 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 1 �� Z C
Zoning Official Date fQ 124�Zo�is
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 11/1/2015 Page 2 of 3
Intake to complete the following:
Y
Is ukA LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
0/ 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 appli
Is parcel on private w 11 or public ater?
If private well, provid Heal 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 r pu is sewe
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 Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
/��4
Q/N
Permitted as: 2 i v� Jai
Under Section: ���, . ��ALP C- • d
Supplementary regulations section:
Parking formula: L�.S
Required spaces:
Y /
Items to be verified in the field:
Inspector:
Date:
Notes:
✓"
Violations:
Y s/
If ist:
Proffers:
6 / N
If so, List: _
zjv 26-7
xoa —
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Varian e:
Y /
If so, List:
SP's:
Y / iO
If so, List:
Clearances:
SDP's
Revised I I/1/2015 Page 3 of 3
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