HomeMy WebLinkAboutCLE201800020 Application 2018-01-29Application for on Clearance
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PLEASE REVIEN'4' ALL 3 SLEETS
OFFICECLE#
USE ONLY
Check # (. �.tSVi Date: 0
Receipt # 113AWStaff: �� . �/___�__ %_),% �v
PARCEL INFORMATION
Tax Map and Parcel: O 6100 —00— 00 — 131U D Existing Zoning � DS C
Parcel Owner:_ ct,_/O� eSy►lfp AzS itlrl .S0yore l,� .
is"" 45� �,�� rd, S�,`� 1y 104 /t �,/A Zip2zq Parcel Address: S$ Cit , cA /p esy; State 01
(include suite or floor)
PRIMARY CONTACT Who /-� QSQ� �Oz�fJ2
should Nye call/write concerning this project?
Address: f55sf Eq5'- e;o %larte� City Chgr10H,5;'i,1[e_ State VA Zip2Zg0
Office Phone: "3L IC;( f Z(7 Cell #Pf - Fax # E-mail -Tpe_2_awV A V R con.,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name V New business
Business Name/Type: 'T�c�20IV C�o���ra
Previous Business on this site C (o+ki nq
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: 2 T,oyeeSa C"('k -% V-A'rIA-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.
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 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 PrintedIWO-s cz-,i goz)e ( a,7—
APP OVAL INFORMATION
Approved as proposed [ ] Approved Nvith conditions [ ] Denied
[ ] B kflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45) ] , x 117.
[ to 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 Date
Other Official Date
CounfN of Albemarle Department of Community Development
401 Mclntire Road Charlottesville, VA 22902 Voice: (434) 296-SN32 Fax: (434) 972-4126
Re,istd 1 1 02 201 � Paie 2 ref
Intake to complete the following:
Y / `" )
Is use in LI, HI or PD1P Zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / @
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until ive 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 fonn.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
1s parcel on septic or public serer?
Y / `J
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pennit.
Permit# tntov\a to-vlie �S�Pa+ e f'tR1�
`V_ � r
Y /6)
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit ##
WVVI A I%Ltr� � Se f4yOto, petrrtf
Zrnino com lele the followin
ns:t:
vari e:
Y Nt
Ifs 1st:
Clearances:
Reviewer to complete the following:
Square footage of Use: 2 ��
Y /
tied as:
Under Section: 'L�- 2. 1
Supplementary regulations section:
Parking formula:
H.JS )040 f12 �Slud � cen�rf
Required spaces: 3
Y f N
lten , o be verified in the field:
Inspector:
Notes:
Pr:/N
s:
Y
if _ist:
SP's:
Y/N
If so, List:
M l-- S 6
SDP's
soo5'— 37
Date:
Rel iced 11 i 1 ,2015 Page 3 of 3