HomeMy WebLinkAboutCLE201700058 Application 2017-03-01Application for Zoning Clearance
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CLE #I-7—
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OFFICE ONLY
MIN IC97 17
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0 1 I W 0- 03 - 0 0- 0 19 A Q Existing Zoning Ne.�5�. bor �-D c 4 M olLj
Parcel Owner• t^) (— I O +n C 1 C
Parcel Address: 3 9 1 8 L e- \pX Arc. #410 City LN rAr � O:'tGiv•t► C. State J A Zip-aa101
(include suite or floor)
PRIMARY CONTACT
C
Who should/we call/write concerning this project?
Address: 6 M c.f . h o A C. City C.oron-. n c t 6gf State L A Zip l-1
Office Phone: {_) Cell #53o -00-10 Flax # E-mailSe f(rtr••itare1��r.N1 • Coe^
APPLICANT INFORMATION
Check any that apply: of Change of use Change of name New husincs
((Change /ownership
Vs
Business Name/Type: �J �r / y } r �, � �, O r� ' S A p 1 G �n. r. ; S 10 C
Previous Business on this site _- %\1 L W
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: f t-; 3 e- r g to t c t S t 3, S ti• 41 St
C\0 sp�jtfj- r\e xl[\.-OcS
"'Phis Clearance will only be valid on the parcel for which it is approved. If you change. intensify or move the use to a ne%v 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. 1 also certify that the information provided
is true and accurate to the 'tit of my knowledge. I have read the conditions of approval. and I understand them. and that I will abide by Ihcln.
Signature Printed Te- ReA
APPROVAL INFORMATION
j Approved as proposed t Approved with conditions t Denied
Backllow prevention device and/or current test data needed for this site. Contact ACSA. 9774511. x 117.
No physical site inspection has been done for this clearance. 'Therefore. it is not a determination of compliance with the existing
site plan.
j j This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official Date/ 0i 7
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 1 1/02/2015 Page 2 of 3
Intake to complete the following:
Yl&
Is use to LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CFR) packet.
Y/tre
Will 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 o public wate .
If private well, provide Healt epa ment 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 sewe
VY/N
ill you be putting up a new sign of any ki nd? If so, obtain proper
Sign perm. 6-75
Permit /t , ()� 6 c)
YIN
ill there be any new construction or renovations?
If so, obtain the roper Permit.
PermitN�a�l b-�a68a-AL
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
/N
Permitted as: r f,'
Under Section: lid"
Supplementary regulations section:
Barking formula: �/
L
Required spaces:
Y/N
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y /
If so, isC
roffcrs:
� / N
If so, List:
2 v t l— L/
z.�1-•7
Varia ce:
Y/ V)
If so, List:
P's:
/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 f'lage 3 of 3
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ALBEMARLE COUNTY, VIRGINIA
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