HomeMy WebLinkAboutCLE201700280 Application 2017-12-15Application forZ min leara ce
CLE #
1y�iP�P
OFFICE USE ONLY
PLEASE REVIENV ALL 3 SHEETS
Check # Cos h Date: �2
Receipt # ML 11 ZI b!3- Staff:
PARCEL INFORMATION
Tax Map and Parcel: C3—S -O (-C��Cc��`yyO Existing Zoning �GC�
Parcel Owner: I I E�MpiJ' �EA� , y rlCSc.Qt�� S < < t L-t—C
lSJ3 -
Parcel Address: 002S L((3rzA(LY y*f- City State \/ E4 Zip 229 3
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerting
this project?
Address : �42 r1cyc4t City State V 0, Zip M'i32
Office Phone: 292- 4S4E I Cell # ZLWA %l [n Fax # r-J%KA E-mail
GTA Oc i (� A J t` v SS E L<— VV1 A 1 L • CGv�
APPLICANT INFORMATION
Check any that apply: Change of ownershi _ Change of use Change of name New business
Business Name/ ype: ->i r_r SNb P - TAtu r�s�, ( � �t,.� t�►�
d
Previous�usiness on its site !!S(a M C-
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, n ntber of
vehicles, and any additional information that you can provide: r% c= rAPc -5S�
Imo- i2 trnnn�-flt�g P��.c��� ^�Pfkc� w c-t-✓l ►� A ,- �A•rLt.�r�� ���s�
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 hown or have t e owner's permission to use the space indicated on this application. 1 also cerlify that the information provided
is true and accur t t e best o nowledge. 1 have read the conditions of approval, and I understand them; and that I will abide by them.
Signature) Printed POJ�-- ��SSeSZ-L
AP OVAL INFORMATION
IV Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] cHow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x l l 7.
[ io 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
Loning Official Date i L J_ y17
Offiev Official Date
Count.v of Alhentarle Department of Community Development
461 Melntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Rcvi�ed 1 1 02 2ftl � Pate ? cif
Intake to complete the folloi ir>g:
Y /0 Is us in U HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y N
Wi t sere 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 IN,ell r�,patmeni
If private well, provide N forn.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic,Ofpublic sewer?
Y N
1��i11 you be putting up a new sign of any kind?
Sign permit.
Permit # I e V jrLOS fn
If so, obtain proper I
Pei pml
Wil ere be any new colstruction or renovations?
If so, obtain the proper Pennit.
Permit #
62O16-37 N G
Reviewer to complete the following:
Square footage of Use: 5 1 l)
Y/N
Permitted as: 2.0. (A) C�t�
Under Section: �Q}Ui1 i - Spet I �
Supplementary regulations section:
Parking formula:
pcp lei Floe( qtcc,
Required spaces:
Y,N )
ltejkzeo be verified in the field
Inspector : Date:
Notes:
RCS i�cd 1 1 '1'2015 Page 3 of 3
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