HomeMy WebLinkAboutCLE201700074 Application 2017-03-27Application for Zonin. Clearance
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CLE -7 -7
OFFICE U E ONLY
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PLEASE REVIEW ALL 3 SHEETS
Check # Date: I l-7
Receipt # 11-1,f(p-7I Staff: J
PARCEL INFORMATION
Tax Map and Parcel: — 0 k t Existing Zoning (� �
Asoma '— /los
Parcel Owner: `olo EdV1&YY1 L—
Parcel Address: \Olb ��n0y11 GPy� J' City e" V 11lL State V /-'1 Zip 2z io
(include suite or floor)
PRIMARY CONTACT
Who
should we call/write concerning this project?2td
Address: L- op LOCu'-�_{- f L t G City C-J t1\e-- Statey n Zip ZZ5�0
Office PhoneM3 V_n -(04 a>Cell # Fax # E-mail Ye ►d pj -AbmCJcm . C0 m
way-%26 -16&0
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: cJ�-e• L^L.� / ���'IC�
Previous Business on this site \ ClW O T�ice_
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: D (-F; cC- 5k. F -
h b bus; ncSS \J e%I 6� S
*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 th5jwAp or have the owner' ermission to use the space indicated on this application. I also certify that the information provided
is true t ebe my edg . I have read the conditions of approval, and I understandthem, and that I will abide by them.
Wacce
Signat t
Printed Y !�-
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, xI17.
[ ] 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 oe Date ��/Z
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 11/02/2015 Page 2 of 3
Intake to complete the following:
Y /(l
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will t ere 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 or puq ie wat
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 applies
Is parcel on septic orublic sewer.
Y /
Will be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y ill the / Q
Wre 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: - 3 7 -
/N
rnitted as:
Under Section: 23 .2
Supplementary regulations section:
Parking formula:
Z�� A;,-k
Required spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/C6
If so, ist:
Variance:
& / N
If so, List:
SP's:
Y/]T
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
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