HomeMy WebLinkAboutCLE201800083 Permit 2018-05-01^ `�J
APPROVED
Application for Clearances `,«a'm��
CLE#GZoning
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONL
Check # CU Date: �' 1
Receipt # Staff: VV
PARCEL INFOR O �
Tax Map Parceel: � ) 611 �
and I U � Existing Zoning ���� X�
Parcel Owner:s l oyo O� ��� �j% I'Awn
Parcel Address:315 -Four I -en City CIV� CG �11UState Va Zipl8Aj
(include suite or floor) n
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PRIMARY CONTACT
Who should we call/write concerning this project? gGVI5L�C (�
Address jt'(4 O�(ax-ri CityV 1 l ltState VA Zip a27 1
Office Phone: (_) Cell #N-0,H%_ Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name w business
Business Name/Type:^ I l 1 ' (2- a ICQ "1 C1
Previous Business on this siteTyt& UVC11QI�a� £ �e �A (9
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any add,�tional information that you can provide: 9 41 r'Y1
o a.,✓Ie Q
*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.
n or have the owner' ermission to use the space indicated on this application. I also certify that the information provided
I herebyQaccurate
I understand them, and that I will abide by them.
is true a best f my knowl dg I have read the conditions of appr2-0-cA
92�SignatuPrinted4cJ1yna*1k_
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x1 17.
[ ] 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
Zoning Official Date S
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 I I/1/2015 Page 2 of
Intake to complete the following:
Y /,1-e,
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / x,
Will there 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 apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o u Iic se ?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: ti ^3 9 l E)
YJ/ N l
Permitted as:
C Y
Under Section: � � !a , l
Supplementary regulations section:
n1&
Parking formula:
�� 5F i� (0ayf (j�Qeti
Required spaces: ,
I(X' 10 G
Y k N I per �,r � oti( r°
Item be verified in the field:
Inspector:
Notes:
Date:
Zoning to complete the following:
ns: Proffers:
Y / ij�l.
If so, List: If 1 so, List:
Vari ce: 's:
Y/N Y�/N
If so, List: If so, List:
S Pdc)U ti 0 (M(p
Clearances: SDP's
L� Roi7 t0a3; SP?QO i1xOQ(c
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Revised 11/1/2015 Page 3 of 3
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