HomeMy WebLinkAboutCLE201800246 Application 2019-01-25'.PPPOVE
Application for Zoning Clearance _:
CLE#� - ()nol-q�Q ;,,
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 2101057ZA
Date:
lReceiPIN 11 lP n Starr:-7- /,7,t i nP
PARCEL INFORMATION
Tax Map and Parcel: _ 01J1 M J+ 00'M rK.;a0 [) Existing Zoning d
Parcel Owner- 24$lt SITe—f—I SriO► t%Qri V 2r�}�1 rt� (�(�
Parcel Address: a qs QjYt'hjaJ- WM kA�—city _� kka" kState V14- Zip ;W
(include suite or noor)
PRIMARY CONTACT
Who should we calVrvrlte concerning this project?
Address: d '54"" City W 1l,��1late n Zip _21
Office Phone: (U%g4 ID4'ell # Fax a 33(t-140 mail V r@yp,,e S6mm j{�-g�
INFORMATION
I Check any that apply: _,LChant;e of mvnership —_ Change of use Change of name New business
Business Natnellype:
Previous Business on i
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 provide: Ce d-n IL 2AAI,p a hrtn t r zo
*This Clearance Hall 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 o%wices percussion to use the space indicated on this application. I also cenify that the information provided
is true and accurate to the best of my latowledge. I have read the conditions of approval. and I understand them, and that 1 wilt abide by them.
�te
Signature U `11 � Printed V U kpcNe,
APPROVAL INFORMATION
[ ] Approved as proposed [ } Approved with conditions [ ] Denied
( ] Backttow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, xI 17.
[ J No physical site inspection has been done for this clearance. Therefore, it is not a determination ofcompliance with the existing
site plan.
I ] This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Orteial Date l % �. / i q
Other Official Ci Date
County of Albemarle Deparlment of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 fax: (434) 972-4126
Revised 11/1/2015 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 /
Wi 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 pu c wat
If private well, provide Healt rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that apCh
Is parcel on septic orer?
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 #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: cAJ�y
permitted as:
Under Section: o4�i a
Supplementary regulations section:
Parking formula:
�s�cwrr► = l3f taro !j lrnno
Required spaces: t >9
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violas:
Y/(N11
If so, ist:
Proffers:
Y/N
If so, List:
riance:
4/ N
f so, List:
SP's:
Y /
If soNN
, tst:
Clearances:
ac�i- o
SDP's
NnI7-a -
I -�l
_ a�a
1 �o
aol�-y jig j28 I 1'
180, l,` olriCba ►5 �� ,
�
10 3,116�1 `1S, ��d Revised 11/1/2015 Page 3 of 3