HomeMy WebLinkAboutCLE201700066 Application 2017-03-10onin Clearance
Application for Zoning
CLE # tv1:? C106 /
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY /
Check # U 5- Date: /
Receipt # Staff: -
PARCEL INFORMATION
Tax Map and Parcel: 7(, — j — Q Existing Zoning
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Parcel Owner: c.
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Parcel Address: \ city b (CAJ BSc State 0 0-k- Zip
(include suite or floor)
PRIMARY CONTACT
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Who should we call/write concerning this project? CO V\ ` C� Q V` C5
Address : 2 F1 nC�LWN 44City(�(� State U C�C Zip
Office Phone: 2 Cell # 3 Fax # E-mail.,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use C Change of name New business
Business Name/Type: C-) /r-,4q/ z5 fFcr
Previous Business on this site
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:
*This Clearance will only be valid on the parcel for which it is approved. If you 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 m owle e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 1So
APPROVAL 11VIrORMATION
�J 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 Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
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Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y /C1
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /61
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 well ter?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic or p se
Y
Will u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Perm' #
Y/
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: 0 J
�b/N
Permitted as: `=F—�\ ► ��t� )
Under Section: 23 • Z , /
Supplementary regulations section:
Parking formula:
Requ' ed spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so, st:
Proffers:
Y/r)
If so, ist:
Vary ce:
Y /
If so, ist:
SP's:
Y /
If so, ist:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3