HomeMy WebLinkAboutCLE201700214 Application 2017-09-25Application for Zoning Clearance;°``
CLE # 20
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # x Date: Z� �
Receipt # 012Cj 22Zy, .+T' Staff:
PARCEL INFORM I N 1I11 hh i hh -7 3 os-9 / P p� ((��jj (�_
Tax Map and Parcel: Q� uV ' � 6 V I � 0 V Existing Zoning UA lit; . , J (���
Parcel Owner:
Parcel AddressiiU60 60 fo a� E6 St City Cht1V (6 JpS Y JJbStme -0 Zip nn`A6J
(include suite or floor)
PRIMARY CONTACT .j
Who should we call/write concerning this project? �0 6� � (� � Cud i e(O
Address: 69 * f on; L G Aqe City SOWlefS C T State N 1 Zip 060
Office Phone: (32-) 732- of 69NFax # E-mail a40UX eC(eI 1 ' 6a►1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
0
Business Name/Type: 1 �40&y �QIIC_1 ' �NOU
Previous Business on this site
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: 9 D /► l4 0/l do iz 1ZI 6 P Y)
5 J��uy
T
*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 pennission to use the space indicated on this application. 1 also certify that the information provided
is true and accurate to the of my knowledge. I have read the conditions of approval, and I them, and that 1 will abide by them.
/best understand
Signature C����I � Printed t 1� 0
APP VAL INFORMATION
[ 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 C Date
Zoning Official 14 Date ,� f
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
Intake to complete the following:
Y <�
Is use in L1, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /ON
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 o u lic water?
If private well, provide Heat epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or Witlic se ?
Y /UN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /(N J
Will 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: I5`k
Y®N
rniitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector :
Notes:
Date:
Vns:
J
If List:
ProffFrN
Y N
If so, ist:
V e:
N
1 ist:
's:
Y/N
so, List:
i IBA—Sv,�
Clearances:
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Revised 1 1/ 1 /2015 Page 3 of 3
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