HomeMy WebLinkAboutCLE201800025 Application 2018-02-05Eat. the Albemarle County
npn.oartment
Applicatianm or zoning Clearance
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PLEASE REVIENV ALL 3 SHEETS
OFFICE USE ONLY /
Check #off/ _ Date:
Receipt # S Staff:
PARCEL INFORA'IAT ON
]17ap U � b � 61 10p
Tax and Parcel: o Existing ZoningfIonned�/�/y ,
o
Parcel Owner: ! TRAINI
Parcel Address: j 8Q (j' ;Z PAAgDa Cite C, #' gl,yf �(,� State VA- Zipt,2�//
(include suite or floor) —` `i
PRIMARY CONTACT
l,�
Who should Nve call/write concerting this project? L.�,\j I p q,-j
Address : Z �4 Cite R4jC'CFRQ11k State 1//t` Zip 90
Office Phone: (44) 4 Cell # .57/ A426 313q Fax # 0-I'm ? lAmr.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: — /4 tl L �t-t
Previous Business on this site T —CAU'
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:
"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 cenity 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 t the best of my knowledge. 1 have read the conditions of approval, and I understand them, and that 1 will abide by them.
Signature Printed _/�4 A,1 72 JI
APP OVAL INFORMATION
[ \r p roved as proposed [ ] Approved with conditions [ ] Denied
[ kflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x l l T
[- 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 — � Date �/J�
^/ a�T'
Loning Official �ry� �C �' V Date
Other Official Date
County of Atbernarle Department of Community Development
401 'McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
7"
R(%% ised 11 '02 2015 Pave 2 of J
1
Intake to complete the following:
Y / >9-i�f )s us LI, Hl or PD1P zoning? ]f so; give applicant a Certified
Engineer's Report (CER) packet.
Y/N
`,tl'ill re 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 ublic water'
If private well, provide Health epartment fonn.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
—
Is parcel on septic o �seewer.
Revie«°er to complete the following:
Square footage of Use: 1600
ennitted as: bey S6 p
Under Section:
Supplementary regulations section: ( b \ /
2�•z-1 �
Parking fonnula:
100 tab ft1Q►�p��r�e,
Required spaces: I
Y/N
Item . be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so; obtain proper
Sign permit.
Permit # teed 1pcj �tQ Se�pt`'te pi'dt0t+
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Pennit.
Permit #_
VVG'JiGi
zonin to complete the folloivin :
Violations:
Proffers:
Y/N
Y/Nt
If so; List:
If so, List:
RS= R
Variance:
SP's:
Y / N
Y / N
If so; List: �ci8s-5y
If so, List:
jyq - t0
t
Clearances:
CLE7.ObS'SL
SDP's
63-33
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