HomeMy WebLinkAboutCLE201700275 Application 2017-12-08Application for Zoning Clearance
CLE # ��I 'l () -7S
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check## �iYCC�i71 �Q/� Date: 717
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Receipt ## Staff:
PARCEL IlITFQRI���l'�[ ' � 0 - �� ®� � J� CO /f �(�
Tax Map and Parcel: L) (� O o Existing Zoning /_ �f�r� � u111
Parcel Owner: o
Parcel Address:_o73� #V olr "�J' A� City State �� Zip
(include suite or floor)
PRIMARY CONTACT
'Who should Nve call/write concerning this project? �j/J U YJ J78yla n 4r
Address: Cih' State Zip
7/ - 3746 E
Office Phone: Cell #t Fax ## E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name l\tew business
/
Business Name/Type: �%' lyp" n C i-u tle �G /ram'//�5 5
Previous Business on this site
yes
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: '%je 'et_nY>1OI/e� f�rn®,j`�'1��
'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.
1 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 accurate to the best of my knowledge. 1 have read the conditions of approval, and I understand them, and that I will abide by them.
Signature p' ?e?/J�-f�C. Printed � �/e� �P " %7G 1� e") e C
AP ON7AL INFORMATION
[ t4 Approved as proposed [ ] Approved with conditions ] Denied
[ prevention device and/or cun-ent test data needed for this site. Contact ACSA, 977-451 1, x 117.
]/ackflow
[ 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 imvdBate I Z/Y/r�
Zoning Official aA bate_
Other Official Date
Count) of Albemarle Department of Community Development
401 Mclntire Road Charlottesville. VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
m
Rr-vi'ol 1 1 02 -)Ol , Pa�c 2 of i
intake to complete the following:
Y /( is us n LI, Ill or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
«rt tere be food preparation?
If so, give applicant a Health Department form.
Zoning revieNA7 can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private ,%%,ell ublic water
If private well; provide He a merit form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app . .
Is parcel on septic public sewer?
Y / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pen -nil.
Permit # ww 'iP vve SiV-' O �C pPlm-tt
Y / N
Will there be any nexa7 construction or renovations?
f so; obtain the proper Permit.
'ermi" Wculd felvire Se
ptit,4c, Feml-,t
Zonin to corn fete the followin ,
Viol ors:
Y N
ifs tst:
Variance:
Y/x--,
If st:
Clearances:
2 0 j7- 26N 171 't1A1�1
2.a � r .- n� U�I� , ►3�� 11 �
Zo12— V6_q_
Reviewer to complete the following:
Square footage of Use: _ � 0O t l 2,
Y/N
Permitted as: Pi0f(%IOyl jCp� jtl(�Vd1��
I11e ica.�
Under Section: 23, 2-1
Supplementary regulations section:
Parking formula: 1 t202> °r lPmployQE tj/(�tPv�t
Required spaces: 3
Y N
1te be verified in the field:
Inspector:
Notes:
Proffers:
Y / N
If so, List:
SP's:
Y/N
If so; List:
SDP's
Date:
Reri�ed I Ir1,2015 1'a2e 3 ref 3