HomeMy WebLinkAboutCLE201900006 Application 2019-02-25F'PPROVE[)
by the- Albemarle County
7 "f
Application for Zoning Clearance
4
PLEASE REVIEW ALL 3 SHEETS
OFFICE U E O Y
Check # Date:
Receipt # Staff: -
PARCEL INFORMATION
Tax Map and Parcel: 041 1A10 `d (" 0 C _ Of) �00 Existing Zoning C Cemy4eVe-I t
Parcel Owner: L,L C
Parcel Address:_ "1 14 ��� C L, a' O City ( a It JState 'A ' Zi ZZ 0
P
(include suite or floor)
PRIMARY CONTACT
Who
should we call/write concerning this project? cc, ( t l
Address : D W�-,t,N a City State V+f� Zip
y z��9 h I
Office Phone: ( ) Cell # 4 ax # E-mail ��la �1U✓vq- 5, y bJ 609Atc C0
��S' 1 Z Z �
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
j 1 I C' �l'4 ` �--
Business Name/Type: `J i 1� ��1L N}� J 111 Z o (B Acc- a I
Previous Business on this site �✓ ! L Col ILC f'�
Describe the proposed business including use, number of employees, n mber of shifts, available�arking spaces, number of
vehicles, and any additional information that you can provide: _ I '0 Q IL F 14 ( (p
Z e S L 5�— ' .'j t r
*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 my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature /+wnC l r �/- %�r,w� 6 �� Printed 4
�,C .,�
AP,?ROVAL INFORMATION
�j Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 11, x 117.
[ ] 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 2—5 f T
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 1 1/1/2015 Page 2 of 3
Intake to complete the following:
Y /(N�
Is use L1, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will ere 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 o publ�ivater?If private well, provide Healt orm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or ublic sewer?
Y/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
O/ 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: Q
Square footage of Use: /7 00 1 [ Soy, of
Y / N
Permitted as: � el C , l 54,95
Under Section: 2-7 , 2, I C c 1
Supplementary regulations section:
Parking formula:
M
Required spaces: /7
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Viola'tins:
Y /�/)
Ifs Est:
Proff�
Y /�-�t
Ifs st:
Varia
Y/
If so, List:
SP's:
Y/O
If so, List:
Clearances:
GLE ZdC�- z55 C. �l lut.,)
SDP's
200� -� 8
rg'Is - z�
Revised 1l/l/2015 Page 3 of
I
Hookah F'RR
preparation Preparation area/ storage/ drinks /washer 3 department think
room rl
'-"ft* M RR