HomeMy WebLinkAboutCLE201600205 Application 2017-01-17Application !Mftnin
Clearance=-►,,1yCLE � � �� � ,
OFFICE LY
U
PLEASE REVIEW ALL 3 SHEETS Check #NW, Date:
Receipt # i(1 klan Staff:
PARCEL INFOR
Tax Map and Pnrcel:
Parcel
Pnrcel Address: am W I I DON V City _
(include suite floor)
PRIMARY CONTACT Wl
Who should we call/write eonLcerning this �pro)ject? ��
Address �(rrl
�� �) [li>f�1� pz* City I
Existing ZoningQ-n
State —NA , Zip
2�1 G Zip O
Office Phone: (,J Cell # �'V'ZG� -I�fax # E-mull�� D.
State U4
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name Nety business
Business Namcffype:
Previous Business on this site— j}
Describe the proposed business including use, number of employees, number ctirshifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
AI_ t t - r. , _ T
'This Clearance will only be valid on the parcel for which it is approved. Ifyou change, intensify or m e the use t a -cw location, a new Zoning
Clearance will he required.
1 hereby certify that 1 of%m or ha�v the ownces pemtission to use the space indicated on this application. I also certify that the information pmvidcd
is true and accurate tothe best of my knowledge. I have read the conditions of approvul, and I understand them. and ilia I will abide by them.
Signature _ Printed_ 1C� Q/jSS
APPROVAL INFORMATION l�
J< Approved as proposed [ ] Approved with conditions [ ] Denied
[ J Backilow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 1I, x 117.
[ J No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
I J This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official s Date,,,1.4
Other Official
County of Albemarle Depariment of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/1/2013 Page 2 of 3
Intake to complete the following:
Is j N�
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
ill 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 1public water?'
If private well, provide Healtealnt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic o public sewer?
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 r ob1 er r
Permit # (�
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 1 2,-
N
�/
ermitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y /(29
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:troffers:
Y/N
If so, ist:
if so, List:
Variance:'s:
if o, ist:
�Y )/ N
so, List:
Clearances:
SDP's
� 2
iTA--
Revised 11/1/2015 Page 3 of 3
,llbemarle County
Planning Application
Community Development Departrr
401 McIntire Road Charlottesville. V..A 22902-4:
Voice : (434) 296-5832 Fax : (434) 972-4
TMP1 056A2-01-00-07000 I Otivner(s): PIEDMONT REALTY HOLDINGS III LLC
Application # I CLE201600205
inrvrcriA i 1�rry
Legal Description ACREAGE 17-18-19
Magisterial Dist. White Hall Land Use Primary Open
Current AFD Not in A/F District Current Zoning PrimarP Downtown Crozet District
APPLICATION INFORMATION
Street Address i 2025 LIBRARY AVE CROZET, 22932 Entered
Application T�,e Judy Martin Ir
PP oP Zonifng Clearance .{E312+316
Project
Received Date
Closing File Date
Revision Number
09/08/16
Received Date Final �� Submittal Date Total Fees
Submittal Date Final Total Paid
Comments
Legal Ad
MUHSEL COMPASS WEST LLC (LTD. SERVICE RESTUARANT)
InkUii APPL1CAIIUrv(S)
! Type Sub ADDIIGatiOn I tsrrana nt
iAPPLICANT / CONTACT INFORMATION
$CDntactT larrae Address City State 2ip Pure PhonCe
Owner/Applicant PIEDMONT REALTY HOLDINGS III LLC 6525'WOOD BOURNE LPG 1CROZET VA 22932
Signature of Contractor or .Authorized Agent Date