HomeMy WebLinkAboutCLE201900060 Application 2019-04-16Application for Zoning Clearance
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CLE # �b i - �P
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Date: 3 I
Receipt #
PARCEL INFORMATION /� l Tax Map and Parcel: Z�6 • • Vf fisting Zoning P`,
Parcel Owner:
Parcel Address: /
�n COR 11 -,aCitY State i 1 Zip Zl�U
(include floor)
suite or
PRIMARY CONTACT
Who should we call/write concerning project?
this
Address : to`L city l
Y State
s4 Office Phone: t �S On 3- I ell # Fax #-IlaGS' E-mail w_. ina*461
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:
Previous Business on this site
Describe the proposed business including use, number of employe.ps, number of shifts, available parking spaces, number of
vehicles, an an additional info m ion that you can provide: WkU44 1 1
1 55► g-,;
*This Clearance will only be valid on the parcel for which it is approved. If you cTiange, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify hat 1 o or av the o ner' ermission to use the space indicated on this application. 1 also certify that the information provided
is true and ace r t e o y 1 e. I have read the conditions of approval, and I understand them, nd that I will abide by them.
Signature Printed (Q)Q L
APPROVAL IN ATION
`.� Approved as proposed [ ] Approved with conditions [ ] Denied
Backflow
[ ] prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, 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 1 Date
Zoning Official Date
!
Other Official Date
uuuty unlucunane uepartment of Uommunity Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11 /02/2015 Page 2 of 3
Intake to complete the following:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / 1O1
Will 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 o Me watte.
If private well, provide 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 septic or p lic sewe .
Y /,6?
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y / &
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:
V N n
Permitted as: A
Under Section: Z _ I "U-7 n
Supplementary regulations section:
Parking formula:.
Required spaces:
I P411A n1 a.N"(?
Y/N ' ' -1
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol ns:
Y/W
If so, List:
Proff s:
Y/
If s , Ist:
Var' n :
Y AN
If so, ist:
Srs
Y
If so"ist:
Clearances:
� rA
SDP's
Revised 11/1/2015 Page 3 of 3