HomeMy WebLinkAboutCLE201700191 Application 2017-08-25Application for Zoning Clearance
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CLE # °I'i `
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OFFICE U Y
PLEASE REVIEW ALL 3 SHEETS
Check #klq� Date:
Receipt # Staff:
PARCEL INFORM
�M
Tax Map and Parcel: 1�; L(17� Existing Zoning P�aL
Parcel Owner:
Parcel Address: 6 7 T PtPr l'tg( n an Pkw,ti(,, Sv,03*00ty C 4 ai to 4tSd/ll L State I% / ► Zip 2Zrt
(include suite or floor)
PRIMARY CONTACT //
Who should we call/write concerning this project? /�f"d( -44 it"I4,,,- So 07'or'r5, Anti: LvV-t t'7ON5
Address: F.O. sey S-0 � City La 045 Sion State VA Zip U N
Office Phone: (f3_!L) 2G3.rf3o o Cell # Af3y 9gy -3yly Fax # y{3y 243 g700E-mail So f t►+�,',r?S Mro$ r, Gays
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Mev(• AA.,ik So 6f►' 7,1eDSA AA45 l..b-,-- Z B-s,Zess 50VO eS
Previous Business on this site (,vs'A0( pars a Cralw
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: p�� t i., rl1 be, JW 01W)d--
4g5lAns ieryecrs ✓r`t, 6vA,d MrAas, ne"- U,.// hG 4 slave,
01C $'AM— S-?M. i,✓t e-mfet in WIA 10 tetplvyees, wi�1n cti .+►Ayinulh of 17.
*This Clearance will only be valid on the parcel for which it is approved. If you c1lanie, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that 1 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 accura 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 `/ Printed I.,/Gu5 14�
APPROVAL INFORM TION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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:
05/t-7
Building Official 02�� Date
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
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Intake to complete the following:
Is /
Is usQ LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y N
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 �1—eiicpawrtamen-t
If private well, provide Healform.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o u lic sewe
Y /8N
Will you be putting up a new sign of any kind'? If so, obtain proper
Sign permit.
Permit #
Y /1�1'i Wil ere 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: ,� -�55
/ N o r-Y
Permitted as: (0 , OL-
Under Section:�y 2
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Vi ons:
Y /
If so, st:
Proffers:
6/ N
If so, List:
Variance:
Y / I)
If so, List:
SP's-
Y /
If so, ist:
Clearances:
SDP's q
Revised l l/l/2015 Page 3 of 3