HomeMy WebLinkAboutCLE201700207 Application 2017-09-12Application for Zoning Clearance;°t
CLE # 20 I-) U U 2J-7
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY 3A CAS- SM / �zS
Check # Date:
Receipt # Staff:
PARCEL INFORA A TION
Tax Map and Parcel: ilk Existing Zoning 0&/
Parcel Owner: T' aC 'V•+-t Rr e / - �u, 1
\
Parcel Address: I6W ��ti 1�C�1 City �ic.c �o t�s`�t Z State V / Zip ZZctC)
(include suite or floor)
PRIMARY CONTACT �j 1 - \ j�
Who should we call/write concerning this project? 9(ivv%: U� t0.� &Vt�\Q►� ! - �O t^0.�^ k v%ci("
Address: �(�, �eS� rocsl� City CV"V-1e-S1JtI State V�\ zip '2?`ADl
Office Phone: ( ) Cell # 13`(-806-` ZtOax # E-mail
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APPLICANT INFORMATION
Check any that apply: Changeofownership Change ofuse Change of name V New, business
Business Name/Type:�,y��, 5�•� YJ , ��►�� { �eSC►'��
Previous Business on this site
Describe the proposed business including use, number of emptoyees numb r of shifts, av ilable parking s ac s, number of
vehicles, and any additional information -that
O��u an provide: ��0.�� Cgr� SCCtF VeS
*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 e owner's per on to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of � kno ge. I have read the conditions of approval, and I understand them�a+nd that I will abide by them.
Signature Printed �Uw�� u` 1Q� 1�w� JAUt cA% "` v"Ck
APP V_41AKFORMATION
[ pproved 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 /Z
//
Zoning Official v (✓ Date r �� I
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
CO -
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
Wi ` ere 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 public water?
If private well, provide 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 septic or public sewer?
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 thefollowing:
Square footage of Use: 0 G `T T t�
Y/N
Permitted as: NON
Under Section:
Supplementary regulations section:
Parking formula:
4.JJ /100Off' (S6pplrU (MtOr
Required spaces:
Y(/ N
Rehm< be verified in the field:
Inspector : Date:
Notes:
ns:
Vio li,
Y ost:
�evod�S oda 04 ted
Pr s:
VarJ'e:�'s:
Y Q N)
If s� Est:
�Y f o,
so, List:
Clearances:
07-13Z. 162/ 1yT, 1, L 1-L3
SDP's
'L00z 3-7
201(�— '2-S19 2�L2U.; Vof / 160
0
Revised I I /112015 Page 3 of 3
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