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HomeMy WebLinkAboutCLE201700170 Application 2017-08-10Application for Zonin Clearance `�,� CLE # 101 ©D ( 6 �� �- .�* OFFICE USE ONLY b -4110111 PLEASE REVIEW ALL 3 SHEETS Check #;XWRo3�li o : Receipt # Staff: &P PARCEL INFORM Tax Map and Parct � "► --� ^ O✓�� �f� OC7 Existing Zoning C Parcel Owner: 1�e7 �( �1✓��y�Y_�/ L L Parcel Addressd0 biyd 1-c 50drity ,,��. ea, Y,,,& State Zip 2,2 9 0 -1 (include suite or floor) PRIMARY CONTACT j �^ Who should we calVwrite concerning this project? w FFAQ-Ikt"',� t t f C�c./L 0 ✓ Address :3 - 35 t— I -et CityVtl1�4— V,1(- State VA zip-Azy1D- Office Phone: (_) Cell #�y�Y -6s 37ax # E-mail M,(AZA APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: yt tyvt j t c1 1'j, C.► 4 S 4-4-4 t-lto- 4� Previous Business on this site -Res - Describe the proposed business including use, number of employees, number of shifts, vailable parking spaces, number of vehicles, and any additional information that you can provide: ` 1 rt, *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 t 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 appr�ovaal, and I understand them, and that I will abide by them. Signatur ✓ �'`-- Printed C'[ (�t. ZA 7jA R ti I b� /v� iQ oV o APPROVAL INFORMATION ( ] Approved as proposed [ J Approved with conditions ( J Denied [ J Backilow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x 117, [ ] No physical site inspection has been done for this clearance. Tlierefore, 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 tY % Zoning Official A Date G Other Official Date D County of Albemarle Department of Conii'it tv'Development fh�' 4 01 McIntire Road Cltnrlottesville, Y-A 22902 Voice: (43 296-5832 Fax: (434) 9724126 A4 Revised 1 1/02/201S Page 2 of 3 �I7I %k 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. RIM 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 pu is w ter? If private well, provide He artment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap lie Is parcel on septic r public sew ? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there 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: /`-�?4 6/ N Permitted as: Under Section: 9 .2 / Supplementary regulations section: Parking formula: S. � y �o Required spaces: Y 0 Items to be verified in the field: Inspector: Date: Notes: Viola ions: Y/CV If so, List: Proffers: Y1A If so`eist: Variance: Y / If so, ist: SP's: Y /(1�I If so``, moist: Clearances: SDP's Revised 1 l/1/2015 Page 3 of 3