HomeMy WebLinkAboutCLE201800010 Application 2018-02-05Application for Zonin leara ce
CLE #_Mjt
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PLEASE REVIEW ALL 3 SHEETS
OFFICE US"' Y
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: V Q" ^Q c ` o olO Existing Zoning r — I
C
Parcel OwC"_'f I VV'h JAA�' l_. w�, CA&S (611elriyc
Parcel Address: I LIo�y V� 1Cd r/� -city 1 V l 6 State Zip V
include suite or floor
PRIMARY CONTACT
Who should we call/write concerning this project? Sus 'V� % VrW 4
Address: 3 Oa& 44 City c'V ( t StateVA Zip
Office Phone: Cell #71 � � 1���) ax # E-mail Aila Z010 6
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name N�rew business
Business Nam�(,
e/Type: P ` cyyo Q At, L00AA'M du tM 00 " lI'q: 0V'UW 0PI
Describe the proposed business including use, number of employees, number of shifts, avai able parking spaRs, number of
veh• es, and any additional information that },ou can provide: %L)LA/IVr
O
"This Clearance will only he 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 ennission to use the space indicated on this application. J also certify that the information provided
is true and accurate to the best of iiiy know] ge. 1 have read the conditions of approval, and 1 understand them. and that I will abide by them.
Signature Printed JU.36110
AP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions ] Denied
[ Vackflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 ], x 117.
[t4 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
a
Zoning Official Cmate
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville. VA 22902 Voice: (434) 296-S832 Fax: (434) 972-4126
Rrvised 11 02'2(t1" Page 2 of"
Intake to complete the following:
Y/N
Is use in LI; H1 or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Wi 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 r public Nvater'.
If private well; provide Hea ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic o public se�tier.
Y/N
Will you be putting up a new sign of any kind? if so, obtain proper
Sign pennit.
Permit �_jt`I�vld �Vlr� St',PAvcn}e �C Y
Y / N
Will there be any new construction or renovations?
If so; obtain the proper Permit.
Permit ##
wD�)\d fe�t,ve, 5trJ(41V\�C' vrn-{
-
Zoning to complete the followin
Violations:
Y/N
If so, List:
alorn�<c�
Variance:
Y / N
If so, List:
IgBi- a3
Clearances:
1016_- W ✓d o MuAh
ti®1y- 1Cq Tr aeh* .5*gll�l t
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2 01Patriot Linhu SC, Clulb
Reviewer to complete the following:
Square footage of Use:
{f
`� U z
Y I fr
Witted as: Qlcr`PSSItI�►� G(�tnln of)(e
Under Section:
Supplementary regulations section:
Parking formula:
'12u6
Required spaces:
Y/N
lte o be verified in the field:
Inspector : Date:
Notes:
Proffers:
Y/N
If so. List:
SP's:
Y/N
If so. List:
2u11-zy
SDP's
Revi,cd 11 1 2til51 Page 3 of 3
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