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HomeMy WebLinkAboutCLE201700149 Application 2017-06-22Application for Zoning Clearance�A CLE # )0 ��AGIN�P OFFICMSEONLY PLEASE REVIEW ALL 3 SHEETS Check #j% Date:Receipt Staff: ✓ PARCEL INFORMATION Tax Map and Parcel: 0_15?QQ - Q©' - 0.S S A O Existing Zoning of t; C 0J / C0Mr1k LtV_ I Parcel Owner: �Ae d 1 c 0 Fv,, e v er i SC Q-11`0i SSOC i A+C S, L L C 10 t-J 1 ord Parcel Address:1490 b[n+oe.S RJUVtttktK Pi CityChuy[ Asyak_ Mate 1%A Zip 2201 (include suite or floor) Si„� 20`2_ PRIMARY CONTACT Who should we call/write concerning this project? IelJ P 006 Address :so I Bt PY1syyt ir- ?jot City Tot,.s.Sov-\ State M D Zip 21 zi'6 Office Phone: CgWJ - S } , Cell # Fax # E-mail _ 0, ►' p C C l 0 �hyt t �C14 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: T d ee W c+CK P h t^ s i c aA T t v QomL A C Previous Business on this site PQ V) AL1 J2S P Hus ; Coal Ili -A, a&O T 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: Q u+-o6t-hevt+ Ah a c C G� Owr/x.✓jty :fve en*QgisS on.- Shi4-1 g AM -S eM *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. 1 have read the conditions of approval, and I understand them, and that 1 will abide by them. Signature Printed f'O�S hUA 4 Ro CC ; Q APPROVAL INFORMATION b4 Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x 117. [ ] 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 Aioemarte 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 L ai Intake to complete the following: Y / Is u n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /6)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 Reviewer to complete the following: Square footage of Use: /�J 3 Y/N Permitted as: ,,41,i, A t-p— Under Section: Z/," 9Y—_9 Supplementary regulations section: Circle the one that applies Parking formula: r? Is parcel on private well or puA�part,,nt If private well, provide Hea form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Y / t1 Circle the one that applies Items to be verified in the field: Is parcel on septic o is sew r? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: Y / N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Violations: Proffers: Y/ Y/6) If so, ist: If so, List: Vari ce: Y/ SP's:.� Y/(N/ If so, List: If so`, ist: Clearances: SDP's Revised 11/1/2015 Page 3 of 3