HomeMy WebLinkAboutCLE201800091 Approval - County 2018-07-12APPROVED
0
Application for ZonfiiteeMYance
CLE
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # C/ Date: ZS 1 Q
Receipt # Staff 1 L UV&711„i
PARCEL INFORMATION
Tax Map and Parcel: _igcc —no —a—()3cLo Existing Zoning PO/A
Parcel Owner:
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Parcel Address: (mil P,,4 lIPP Cityy
(j0A.(0 '))1 Q State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Afti , fj
Address
M
Q*
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:. 19— Lw fl widDaM p�
Previous Business on this site " t �1(� t1g
Describe the proposed business including use, number of employees, numbe of shifts, available parking spaces, number of
vehicles, and information
any additional that you can provide: i,� y
*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 y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatur A t 1__4 Print, Nlwc L, C�5—OJI
APP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow 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 Date / / ,
Zoning Official Date/ (j
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 11/1/2015 Page 2 of
Intake to complete the following:
Y / 0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /�
Wil 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 wa ?
If private well, provide Heal Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or p hDsewe
Y 0
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
/ N
ermitted as: t4 rJw61 ,-
Under Section: ��i,'—j ( �
Supplementary regulations section:
Parking ^^formula:
/ d(���
Required paces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Vio�l s:
Yr "'
If so,''11..,,ist:
Proffers:
Y/N
If so, List:
7-MA
Vari e:
Y /
If so, ist:
'
If so, List:
Clearances:
SDP's
Revised 11/]/2015 Page 3 of 3
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