HomeMy WebLinkAboutCLE201300188 Application 2017-08-31Application for Zoning Clearance0-
C L E # 201_�- IA
PLEASE REVIEW ALL 3SHEETS
0 FFICE US I� Y
Check# J Date: `q
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: ` _ Existing Zoning
Parcel Owner: (,u_L,t,,c_ �,r�cc.LvLc 4
Parcel Address: �',,yr! (G—CIA,z— City State _(%cam Zip Ez__�3
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address Im City <J ((e State (k Zips
Office Phone: (Y3Y) - ao 1 Cell #q3Y, lb&-YY7f Fax # E-mail Slc
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: ?_� va ✓� cuu"tt- 6,1Lk/- ,
Previous Business on this site Z� ra Se— Le L& sa e- -,S.
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:; urrf u u e—
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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 �� �;�� Printed clt�
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, x117.
[ ] 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 (��c
Zoning Official ADate
Other Official �� Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
T,
Revised 7/l/201 1 Page 2 of 3
Intake to complete the following:
Y N
Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
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 oArivate we r public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
it. FAX DATE
(/—'," 04-aj' %— (7 C O
Circle the one that applies
Is parcel o tl or public sewer?
N --g
u ( C&A 1-a 162
ill you ube puttinup a new sign of any kind? If so, obtain proper
Sign permit.
Permit#
itiaf � �e Lcf%�-1-
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# 2-o/3./-790AL
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 3`I +.
/ N
ermitted as:
Under Section:
Supplementary regulations section:
Parking formula:
" 5r
_T
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
ID
If so, List:
PrOTs:
Y
Ifsst:
Variance:
?b/N
If so, List:
SP's: �
y
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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