HomeMy WebLinkAboutCLE201800086 Approval - County 2018-05-01 (2)Application for Zoning Clearance
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CLE # b o 6 TU
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 10 Date:
Receipt # Staff:�%i1 pp t/
PARCEL INFORMA W, u 6 0 3 Qo u u (P� 1 t
Tax Map and Parcel: U LQ Existing Zoning 1�1 L
Parcel Owner: Qaqj 6K/(A1_1(Jf
Parcel Address:3000 A - I Ee&hy,t,( nye, City
(include suite or floor)
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_ State VA Zip
PRIMARY CONTACT I/ �`�� ��bVs�
Who should we call/write concerning this project?
Address: PO Ll� City �'ra ( f)i Qn State
Office Phone: ( j Cell #4Aq b Fax # E-mail klo-1' letOC'l t L cxy
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Tr)e, It oyLn U)e iI u_(2 A ea I o L(.� 1"n&i
Previous Business on this site
Describe the proposed business including use, number of employee , number of shifts, available parkin spaces, number of
vehicles, and any additional
"information that ou can provide: hwbb��, aF�� (� X I O� 01 � �1 nG
Q'o E R('- . 1-� ��i g T YL f xu, k t51
*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 I understand them, and that I will abide by them.
Signature r Printed L 11Q.e,h
APPROVAL INFORMATION
[ vjApproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Back -flow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[Vf 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%'G Date
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y leg
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /�1
Willere 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 puk><l' wa
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic or ublic se 0
Y 19
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Willere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:y
as:9
Under Section.. Z`1' Z . L • Z's
Supplementary regulations n:
Parking formula:
Required spaces:
Y /LV
Items to be verified in the field:
Inspector Date:
Notes:
Violat• s:
Y/i
If so, List:
Proffers:
Y/,1�
If so, List:
Varia e:
Y/Pj
If so"List:
SP's•
Y/,r
Ifs ist:
Clearances:
SDP's
Revised I1/ 1/2015 Page 3 of 3
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