HomeMy WebLinkAboutCLE201700236 Action Letter 2017-10-24Application for Zoning Clearance
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OFFICE US ONLI'
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PLEASE REVIEW ALL 3 SHEETS
Check # Date: --
Receipt # Staff:
PARCEL INFORM IO
Tax Map and Parcel: Existing Zoning �mC
Parcel Owner:
i
Parcel Address: 00 Pj(',1' KMW r,QVj 4 City CO(Ai (Q*a'`tt I ` , State VP Zip229
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? �
Address: 71(.01 ffgf0 C 3 ga bC_ City State w Zip 2Z� I
Office Phone: Cell (!U3 32P-2g07Fax # E-mailCrn� jC_ 660-I(Li Li vai . (o
APPLICANT INFORMATION
Check any that apply: Change of�f//ownership Change of use _Change of name _ New business
Business Name/Type:um d�C' ��. G • / �f �ii�I UX %7 f��� C'` ' r�
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 informat'on that you can provide: (`"�
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l - 2 06
1
*This Clearance will only be valid on the parcel for which it is approved. If y u change, intensify or nitve the use to a new location, a new Zo 11
Clearance will be required. L
I hereby certify that I own or have the owner's pennission to use the space indicated on this application. I also certify that the information provided
is true and accu ate to the best my owledge. I have read the conditions of approval, and understand then, and that 1 will abide by them.
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Signature &f Printed
APP OVAL INF R ATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] 13'apkflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
o 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
Zoning Official 4jj Date 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
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y /0
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, �
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y(N)
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: i3 0 f' F+�'
Witted
as: At�fPSS1tMa� dfCl(e,
Under Section:
Supplementary regulations section: 3
Z,•Z..l (Z
Parking formula:
1 Je laye1, I J(Gen�
Required spaces: 6
Y N
Items o be verified in the field:
Inspector:
Notes:
Date:
Vio ons:
Y N
If so, ist:
Pro
Y
If so, List:
Va ' e:
Y/N
If s ist:
SP'
Y N
If so, List:
Clearances:
SDP's
Revised l I/1/2015 Page 3 of 3
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MUD C KU*N (IEM£NT MIS i AND S NOT YET SEGVN
n8MI)INO Ff - SECOND FLOOR PLAN
�`i�a $5,
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THOMAS B. LINCOLN LAND SURVEYOR INC. alit
671 BBRKMAR CIRCLE 1
to
CHARLOTTESVILLE. YIRGIMIA 22901
7MODEL XI 0.%DATAB\BERKX\DWOS\FiCONDO.PRO 93-0077-00
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