HomeMy WebLinkAboutCLE201800084 Approval - County 2018-04-20Application for Zonin Clearance
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CLE # p
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PLEASE REVIEW ALL 3 SHEETS
OFFICE U ONLY
Check # 1306-7 Date: q-1wA
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: Aak�e (� RC�Ci�✓9 /7-S->�-c�-T 1 a' -Existing Zoning KA
Parcel Owner: �GX2���CGrAu'c iiSS�x ti�nc
Parcel Address: -22f S T(-,f-c . City fit ,-�,rff /�(� State VCt_ Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? te�ru
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Address: /� �yk'►i�l� 7�— City �-✓�e (oCs/c( State Zip���
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Office Phone: Cell # Fax # E-mail fiJjiJr�iC'X+2r�.I?
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name/Type: r z,Y,f( :�d - �\ C�Ge5
Previous Business on this site
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.
I hereby certify that I own or have the owner's permission 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. I have read the conditions of approval, and 1 understand them, and that I will abide by them.
Signature Printedt/ ✓c'��%T���
AOVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Uackflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ 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 i✓r Date '
IA
Zoning Official Date 4 12o���
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
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Revised I1/1/2015 Page 2 of
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi ere 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 on
Is parcel o private well fir public water?
If private we o e ealth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one
hat,applies
Is parcel o septic o` public sewer?
Y /ON
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will
ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the folinwino-
Reviewer to complete the following:
Square footage of Use:
Yam/ N �^�
Permitted as: �/kLS2 ZGtc.e—'r''j
Under Section: se
Supplementary regulations section
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /
If so, Est:
Proff s:
Y /
If so,Iist:
Varia e:
Y/
If so, ist:
SP's:
,�/N
If so, List:
Clearances:
SDP's
Revised 11/] /2015 Page 3 of 3