HomeMy WebLinkAboutCLE201800219 Application 2018-11-16APPROVED
by the Albema' "ounty
Application for Zoning Clearance
CLE#_mil° —2-1CJ
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # 3118 Date: 1 U -1 oL-1 8
Receipt # 1155 - 1fi Staff:
PARCEL INFORMATION
Tax Map (p — A—z
and Parcel: I � Existing Zoning -�
Parcel Owner: e4rArer,,
Parcel Address: �r_Mlnolt TA City �,t"��� State U Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? !Cgk � Ne��r,/\
Address a,i( City (om' U State 1! Zip
Office Phone: �(� �) ' D!) 31ell # Fax # E-mail ]�n2. w 4.,r�o 1�Ce v✓t c as�_ nc�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name 10 _ New business
Business Name/Type: C ,y�e� c1�,Q6 c�T v A
L, c, xyylUe� �-yt?p 3 rL,
Previous Business on this site ( p( ru C_-tv.•.�Q, �,y �� "A
Describe the proposed business including use, number of employees, num er of shifts, avail ble parking spaces, number of
vehicles, and any additional information that you can provide: ('ivn= +,ek Lcr
*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 m knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature - Printed
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, 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 OAT," Date
Zoning Official ADate
Other Official 's ec- LAELL4 Date
lJlgp, uKI
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 1 1/02/2015 Page 2 of 3
Intake to complete the following:
Y /
Is u m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
WillQtere 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 Parking formula:
Is parcel on private well or public
If private well, provide Health De t form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Z
Reviewer to complete the following:
Square footage of Use: ) -j G C-)
Circle the one that applie
Is parcel on septic or pub is se r?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit # 4�
Y / N .
Permitted as: sec, C-rJ Scu-,3—
Under Section: C�A_VVIOV--�
Supplementary regulations section:
Y /
Items o be verified in the field:
If so, obtain proper
Inspector : Date:
Notes:
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
1 ,., , 41. ,,
Ulllll lU GUlll lULC; Lll , ivuv.uaa
Violations:
Y/N
If so, List:
Prof
Y
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
'71 - 27
:75 24
Clearances:
SDP's
Cl Ll
to - i3
Revised I I/1/2015 Page 3 of 3