HomeMy WebLinkAboutCLE201700083 Application 2017-04-05Application for Zoning Clearance
CLE # :�,(7% OGD �"3
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OFFICE LY n
PLEASE REVIEW ALL 3 SHEETS
Check # Date: I
Receipt # Staff:
PARCEL INFORMATION /Q L
Tax Map rf� " A
and Parcel: V Existing Zoning
Parcel Owner: l �� I IUh 4-0tdC65 (_ L. L
Parcel Address:_ ZOO �miVldtk I li 1 City _ CL1a�)G �V++�f� State vA Zip L'L)01
(include suite or floor)
PRIMARY CONTACT __5-in �
Who should we call/write concerning project?yS � t yn
jthis
Address :_'20 1 E • fy ^ i h l% ST • S N1 City Cy1a r� o t �"SV' �j E State S Zip L rn `9 0
Office Phone: ( 9 s?J "6 )� 6 Cell # Fax # E-mail ��b#i�1C�51'►+►'>1'7-li�'1�►Y1C►�tS
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APPLICANT INFORMATION
Check any that apply: Change ownership _ A-- Change of use Change of name New business
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Business Name/Type: y':2Qk1(_ SUJal`4!) S1,001CA
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts available arking spaces number of
vehicles, and any additional information that you ca provide: (c U�+Y - 2 MbV F 0
C S�4c4 40
vl` C�tY1 v F 4LJ ill 6 CAA 'Jt"h, w r,
*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 n or ave the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate e t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed_ IVA0
ORMATION
4APPROVA
pC1 Approved a roposed [ ] 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 -31�/1Zo % 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
Raq
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y / 1 )
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will Otere 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 weHdFepartment
water?
If private well, provide form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic o -public sew ?
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 so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: ✓0; 0J J
(Y/N
Permitted as:
Under Section: 2' / •2-•�
Supplementary regulations section
Parking formula:
Required spaces:
Y/rD 7
Items to be verified in the field:
Inspector: Date:
Notes:
Violations:
Y /
If so, st:
Pro s:
Y / 1
If so, List:
Variance:
Y/
If so, tst:
SP's:
Y/N
If so, List:
Clearances:
SDP's q
Liz
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Revised 11/1/2015 Page 3 of 3
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