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HomeMy WebLinkAboutCLE201700098 Application 2017-04-19Application for Zoning Clearance �� CLE #D/7 )-� �IRGIN�P OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # 1011 Date: L 1411-7 Receipt # q Staff: PARCEL INFORMATION 1� o Tax Map Parcel: O — �lj P 6 - and / (j ( Existing Zoning Parcel Owner: I v L, L, Parcel Address: 1(1 I () R¢, �; N City State tl!q Zip -2.2I!'%/ (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? f u Address :1 9 S k r VB-f- �j e"c.l -br',V t= City a 0 0 1n��sv; J� State li %� Zip.�2 9//- Office Phone: l / �b (� -�))r j Cell # Fax # 996-3S"/ V E-mail S-fieve chi %��'nis �a,c�t Co�u(ydxy, APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name ✓New business Business Name/Type: F[I741 (fart? 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 ou can provide: INnA",J 0W<." . 2 -�; van:�01-�z V,5 514-i-- 4-1 C, _1 M- %= .7 -, � „�-, P. �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 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 my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature L ftoew-� Printed nL-� D h APPROVAL INFORMATION Approved as proposed [ J Approved with conditions [ ] Denied [ ) Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xI 17. [ ] 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 .,vul,ly Vl %lueulaule Leparlment oI L ommumty Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 wII. Revised 11/02/2015 Page 2 of 3 Intake to complete the following: Reviewer to complete the following: Y / © Square footage of Use: _2 R 5 , h, Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. / N O rmitted as: _�►�ti,�p���G� Y/ Will there be food preparation? Under Section: 2<A. 17 If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE Circle the one that applies Is parcel on private well or ublic water? 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 or Vublic sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / Q Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Dning to complete the Violations: If /�'N1 If so, ist: I Vari ce: If / �t If so, Est: Clearances: Parking formula: :7-0� Required spaces: S Y/N Items to be verified in the field: Inspector : Date: Notes: Proffers: Po, List: SP's: Y /0 If so, List: SDP's Revised 11/1/2015 Page 3 of 3 DATE: FEBRUARY 28, 2017 SCALE: 1w = 1'0' AREA: 1,283 SF