HomeMy WebLinkAboutCLE201700182 Application 2017-08-08Application for Zoning Clearance
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CLE# L017rib/92-
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OFFICE USE ONLY
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PLEASE REVIEW ALL 3 SHEETS
Check # Cx�_ Date: Zvl
Staff:clir�)
Receipt #
PARCEL INFORMATION 7_69'-1 Zy1 QOj y95 C
Tax Map and Parcel: %Nj lO Ito -w -cats —131d c) Existing Zoning �^'�'���Yi
Parcel Owner:Gis (j/!1Pr�CGi.[% SCE J �sAtc�,�t' /VIAx,/C7'� - ��GiSS/� �AyE'/ %j
Parcel Address: /607 k1p RD City C,#&jOLlLSSVrLLDState \/A- Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? 1 4OC14A d Tz) z_✓%41-J
Address: I_ 6 f,0c)7_6 e1QGA: B,e, City &1&ZEJ2S\411-,''State
Office Phone: Cell # 44 531 71,71/ Fax # E-mail Zit/ J�� •Z� ��
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ✓ New business
Business Name/Type: \9 Y? "all; PAVIAJC V/_ UTMAk, L L C C2.E �RS'J IIJAIL Y �p4Jw2S >
Previous Business on this site /VO
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: 2 - 3 ,�C� S#iPI`C RUSi�/�5 G,'r1L D
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*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 eyl, z�'1 � n�� Printed 1 �� ZC�TV0,.1A
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APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 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��2011
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 1 l /02/2015 Page 2 of 3
Intake to complete the following:
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y r
If so, give applicant a Certified
Will there 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 well o p�artment
If private well, provide Hea form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic o public sewer.
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will re 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
/ it ' n
Knitted as: (�1..
Under Section: ~, �— I
Supplementary regulations section:
Parking formula:
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Required spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Viola��i��ons:
Y/(NI
If so, ist:
Prof s:
Y/N
If so, ist:
Var ce:
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If so, List:
SP's:
Y/N
If so, List:
fl 2 -fit,
Clearances:
SDP's
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C5 37
Revised 11/1/2015 Page 3 of 3
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