HomeMy WebLinkAboutCLE201700162 Application 2017-07-20Application for- 7ori"(Y Clearanc
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OFFICE t
PLEASE REVIEW.OLL 3 SHEETS Check 9 IOOI`�
PARCEL INFORN'IATION���
Tax Map and Parcel: /I f �AC( L'
11
Parcel Owner:_
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Parcel :address:
(incim e suite or floor)
a
6
Staff:
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PRIMARY COtiTACT
Who .should «e call/G«rite concerning this project)" ���� �i/(.� k C L
Address: QO �6G1� INjb/Ad✓Ile V h� lip �Ztl�l
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Office Phone: Y3T : `1 ,� -- D (� 4 C c'
APPLICANT NET IN:. A TIOo- ►ter;liip _t f ange of n�uue ✓ -'�elo business
Check and that a Is: Chan c
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Business \ame/TNpe: _�irS �l l ��JU rC-C __.GL) ��C is �� /fi e L �L C
Previous Business on this sirc_ �A Sh l cn, 'tj rn' e- �V A I cA J� U ' K—
i
Describe the proposed business including use. number of emplo' ees, number of shifts, a, ailable parking spaces. number of
I
sehicles, and and additional information that you can provide: _
I ills ( learance „ill n)l,\ he ,aliLl oll the Parcel iol' „hich it is approval. 1; WILL chal:L. mtcnsil,\or nuoye the ti�c to a Icev location. a ne,c Zonins
C lear:nce ,ci11 be required. `
I he eby cerut,% that 1 o"cn or h.tre the 01c ner's permission to use dte mace indicntetj on thi, application. I aIko ccitifti that tlic mtonmation Prov i&d
is tat e WILL ;tceurate to the beat kno„'ledLe. 1 hate read the conditions ol'approNal. and 1 underatuid them. and that I will abide by them.
�SI_'nQitlrc L
_ 1 Printed /lie e- v�
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App AL INFORMATION
[ , pprov cd as proposed [ Approv ed ith conditions [ ] Denied
( I Backllotiv prevention dCViCC andor current test data needed for this site. Contact ACS A. 977-451 1. sl 17.
j j No ph-, sical site inspection ftas been don: for this clearance. Therefore. it is not a determination of compliance % ith the existing
site plan. `
[ ] Thi> site complies with the site plan as of this date.
Notes:
Building Official
Zoning Official
i
Other Official
Date `7 Z
p ] i
Date I l
Date
I
Count%, of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 5832 Fax: (434) 972 4126
Revised 11,0212015 Page 2 of ;
Intake to complete the following:
Y /
Is us LI, HI or PDIP zoning?
Engi er's Report (CER) packet.
If so, give applicant a Certified
Y /
Will e be food preparation?
If so, ive 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 pu rc wate
If private well, provide Health rient 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 publi sewe ?
Y / � ou
Will u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / Will`' e 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: I
niittted as: Pirel VU
Under Section: '))+ . �I
Supplementary regulations section:
Parking formula:
Required spaces.
Y /
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
Y: l LN I tK VLA
'lR z _ _ _ _o o -enont and except as may be expressly set fort in the Tenant's Lease.
o en o` store unit sizes. fenom's names and other detailed information respect.^.g x
,V' t^ 'lob~ w ` -. - o-c cif-er common areas, i; not c represenfoficn by _andlord that such conditions erz or
'._ r�= - .•_ I COnlinue to exist throughouT all or any part of 'he term of Tenant's pease.
1 1223
SPACE NUMBER K109A
LEASE OUTLINE DRAWING
This 3 ` =3 ..c= - e r = iiectumf ord cngineenng r cns,
_ _ -e-- represent that this info-•ro-ion
-e:a verify existing conditions. Tenant
'hat all tenants are or will