HomeMy WebLinkAboutCLE201700065 Application 2017-04-28Application four Zon' Clearance
g
CLE # CT
OFFICE US ONLY
PLEASE REVIEW ALL 3 SHEETS
Check# Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 01?-1D 0 - 0 0 -- 0 0 ` DO 10 0 Existing Zoning KA-
Parcel Owner: G ri411D+-l-C S h c. ! i-a ri
Parcel Address: 1 5 4 S R v»41 Ri 11 c, Ln . City No,,A GikeJ eyl state VA zip 22.9 S9
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? �ri ouvi n
Address : 1000 14 Am S4. Unt-f 304 city G a_state XL Zip 60610
Office Phone: (137j jot- 1320 Cell # q, 3 j - `l d -138 (7Fax # sovrT11b ems—" r"
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
r�
BusinessName/Type: Ttt H'W Ci'd-rr Ru11 fyf= .ik)
Previous Business on this site � ei
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional infortnation that you can provide:
3 1< C� ao.
*This Clearance will only be valid on the par=] for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Cleamncc 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 = of my knowled = ry d the condiiio a royal, and I understand them, and that I will abide by thetn.
Signature 1'rinted___lrn Yqvet
�i PPROVALIXIORMATION
[ Approved as proposed [ [ Approved with conditions [ [ Denied
] Baekflow prevention device and/or current test data needed for this site_ Contact ACSA, 977-4451 1, xI I7_
[ ] 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 7'2// �2
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
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
YIN
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet,
Y N
Wi - lie)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 at applie.s
Is parcel on rivate well r public water`?
If private w eallb Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the Cs
' lies
Is parcel o public sewer?
Y / N
Will you be puMix up a new sibn of any kind? If so, obtain proper
Sign permit.
Permit #
Y I N J rpt_,t t r 01
WIE re be any ne►v construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use. C �d
YIN
ermittcd as:
Under Section: A-J 6m 1 �p /�0
Supplementary regulations section: --------
Parking formula:
Required spaces:
Y t N
Ite s be verified in the field:
Inspector : Date:
Notes:
Vi ns:
YU)is
Ift:
Proffers:
Y /N
if so, List:
Variance:
Y/N
If so, List:
's:
Y�i'N
so, List:
Clearances: 05. M"'N's,
SDP's good
Revised 11 / 1 /2015 Page 3 of 3
Eli
FA