HomeMy WebLinkAboutCLE201600263 Application 2016-12-19Application for Zoning Clearance
CLE# �0140,��
PLEASE REVIEW ALL 3 SHEETS I OFFRICE
Check # LSE ONLY
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P A D - - r --,, _ _ Receipt # t-0 7:�_ A, -
- .-••" LIIF VICIVIA I IVIN
Tax Map and Parcel: 011$ OD — 00 00
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Parcel 01vner: Y koci�s -- L j, _,
Date:
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Staff:
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Parcel Address:_, 6 Lr1 city C`r
(include suite or floor) "N�Y Lo iT S� �_ ate V A
PRIMA RV r'n T-rA r- v
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Who should we call/write concerning this project? R Vzl" �« I
Address: 5 l tJ D 1 �L� R U I:-,- City `C E.kLLE1
.State
Office Phone: (ALA) grlls -13 Cell # �� gi 5�i LD�,r(,'g Fax # E-mail hots C
, LXI-A hk� Y. c� ilcMC-15
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name .New business
Business Name/Type:hhgi�f5E
/,/i i�,d C.� 5 T/✓G.
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Previous Business on this site P�ltYiv A
Describe the proposed business including use, number of employees, number of shifts, available park]DA spaces, number of
vehicles, and any additional information that you can provide:
'This Clearance will only be valid on the parcel for which it is approved. If you change,
Clearance will be required. intensify or move the use to a new location. a newLoninz
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 n ue 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.
i Signature ( �� 4
Printed
APPROVAL INFORMATION
Approved as proposed
Backflow prevention device and/or current test data pneed d foroved r lth this ditions Denied
site. Contact ACSA. 977-451 1. s 117.
( ]
No physical site inspection has been done for this clearance. Therefore. it is not a dcterrmination of compliance ith the .s
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official
Date
"Zoning Official
' Date �� d
Other Official
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Re% iced 11 `02,'2015 Page 2 of
Intake to complete the following:
Y
Is use in LI. HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will there be food preparation?
If so, give applicant a Health Department form.
17_oning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o ublic water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
I Circle the one that appI'
Is parcel on septic or ublic sewe .
Y /I
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 # $Qb Nlo — G'lk 3$ - RG .
Zoning to com
Violations:
Y/a
If so, List:
I
i
Variance:
If so. .ist:
Clearances:
Mete the following:
Reviewer to complete the following:
i Square footage of Use:
(y/N
Permitted as: t C Z
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: /3
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Proffers:
Y /,Did
I so, ist:
_i
SP's:
Y
If so. List:
SDP's
ReNised I 1 1.2015 Pace 3 ol'3