HomeMy WebLinkAboutCLE201800150 Approval - County 2018-07-23PV,? '0 .F p e�ation for Zlonin Clearance eft
p\be!!' eat ..` CLE #
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OFFICE USE ONLY
1, REVIEW ALL 3 SHEETS Check # CC, Date: U - 1 3 • l
P1,Receipt # Staff:
0 PA CEL INFORMATION
Tax Map and Parcel: Gy S(3Q " Dc 00 -- (p y ,Z Existing Zoning C.
Parcel Owner: Ae-Gc-sS Rcl -e-eL f�J
Parcel Address: 3,3 (S 13-erKMa-c _Ofck City CA ar loffe--,11-e State VA zipZz�/C�
(include suite or floor) Sw �L�
Z
PRIMARY CONTACT ,
Who should we call/write concerning this project? con .'► e N�'r`� Gs-s
SJL
Address: 33tj-- ,DC, z f3 City C ,r10ftVVL4uw State A ZipZZ10
Office Phone: y� �� �" 1ij �l # (vl i -C/t3-•`iv/ Fax Wq iI %Y Y 3 Z I E-mail C bUfrj-Clj 'ih-e-roe? ke"',
APPLICANT INFORMATION
Check any that apply: __Y_ Change of ownership Change of use // Change of name New business
Business Name/Type:cti! f t Av rJi�t cry /�Cl�/�/�/y %E39zT1! P%. LLB 6139 , /7�,d/o►<<����
Previous Business on this site -e- %ivOLf `ti'am12'v
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 rovide: ���`yr-•y U6wL —! j %{�s*"7 * y/�u
Sul Yf CVt t`2 A Cv C PA- ciw sn i •r11
*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 dfie-Fi knowledge. I have read the conditions of approval, and I understand them, and that 1 will abide by them.
Signature Printed b,4-jw-,
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, x] 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 ���Z' Date L'
Zoning Official Date 7
Other Official Date
t-ounty 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 Paget of
Intake to complete the following:
Y /
Is u in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will 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 or pu2�terIf private well, provide Health meblint form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap�Ep
lies
Is parcel on septic or
Y
Wil you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
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:
'Y, ,f N
Permitted as:
Under Section:
Supplementary regulations section
Parking formula:
Required spaces: CO
Y /?qT-
IterAs t6 be verified in the field:
Inspector:
Notes:
Date:
Viola ns:
Y /
If so, ist:
Prof
Y N
If so, 7Kst:
Vari e:
Y /
If so, List:
SP's:
Y /i.
Ifs ist:
Clearances: _
SDP's
Revised 11/1/2015 Page 3 of 3