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HomeMy WebLinkAboutCLE201700186 Application 2017-08-27Application for Zoning Clearance 0FFICF, USFF ONLY t 26 PLEASE REVIENV ALL 3 SHEETS Check a Date: Receipt ty t;; Staff: PARCEL INFORMATION Tax Asap Parcel: © 60 OC& CQ Existing Zoning e and 6i T_ L— Parcel Owner: f " ldf- 0 C' f' (, _ L' ov RO2F Parcel Address: L/5- ft eaMerCriC4 City _ State Uh Zip '=;_2 (include suite or floor) PRIMARY CONTACT � A Niu_on1 Who should we call/write conecrnim; this project? imCs -to-L y Address: A95WISW 7 S,4w&tASs Cr City C Rto 1 t State VA- Zip =lot Office Phone: (_) Cell #1 q3Y-J1 -712-Ir Fax to E-mail outlook, (O;n APPLICANT INFORM TION �~ Check any that apply: Change of o►vncrship Change of use Change of name New business Business Nante/Type: ��:lAYLRnIt}S t.RySS►n)C-7AVfRNj !�L (, I--yl/ Se tyi,e— Re'S�Uur71Jt 1?4161-1C. Oes ySr.-F Pub f Previous business on this site r (J Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additlonul information that you can provide: fu!/ ser'4re t'csl vxnf t /Z c-mTolu�r , _��hti�lS7_%muh; rKa /n sl��g,,.rr� Cen4r 11mirics 'ntis Clearance will only tk' 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 heat I own or have the owner's permission ul use the +pace indicated on Ibis upplic;uion. I ako certify that the inlonnation provided is tnic and accurate to the tw•st of my knimiedge. I have read the conditions of approval, anti I understand them,; and that I will abide by them. Signature _ �—�-- Printed �m8r e J) rLLO APPROVALINFORMATION 'J>�j'Approved as proposed ( ) Approved with conditions. ( ] Denied ( j Backflow• prevention device an m current test data needed for this site. Contact AC SA, 9774511. x 117. { j No physical site inspection has twen done for this clearance. Therefore, it is not a dclermination 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 f County of Albemarle Department of Community Development 1 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 1 V02/2015 Page 2 of 3 Intake to complete the following: WIFE, Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. 0 /N ill 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 or ub ' ater? If private well, provide Hea artment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that apublicplie Is parcel on septic or wer? 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: Y/N Permitted as: Under Section: 6� C d• Supplementary regulations section: Parking formula: ;��tc. .IA Required spaces: /-5 Y/N l Items to be verified in the field: Inspector : Date: Notes: Violat► s: Y/ If so, ist: Proffers: 6/N If so, List: Varian e: Y /( If so, ist: SP's: Y /O If so, List: Clearances: SDP's n St /� —Y ��� Revised l 1/1/2015 Page 3 of 3 60K-096i6£6) W.up.p�mg¢!p¢alv-. m euntl I wivawo0 5L09-9s61o6s) x¢d 60W-096i6£6) Z£6ZZ VA'1—:) 1, :ia8eu¢W Pafold U6ZZ VA'Poomuaal`.J 00b a1mg'a�o�lJ 7fw-a44eaH S[OI A lea au!M ap ajeJ PH uope7s poomua D M :ssaippe 7aa(oid °e ?if�lf —I¢P •Jlij saaplma.z g etp�y eonl ¢p :loafad ti uawolsnJ Y 3 Y Y ttl N S N Ti S a) 8 �ir .on r.zt oar a a � •e.• z�F tr2r d .6/ttr.Lt .I,L fi-.fi ats ztc.m� aoo o a Y ❑a000a❑ ❑❑ 3 3REF O = A c E U t tr y t a IF � i O s � 2mocy 2U�mcbNN� Yam"ANomre �mxo`a o� A E E N t Y�m�NNom��oScmm o oaE 'n3LLa`c)c)ir _an�n dn8mo,o �A•n dA ,o'