HomeMy WebLinkAboutCLE201900078 Application 2019-04-22Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
YY N
'Gill 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 a s
Is parcel o private well r public water?
If private we , provi e 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 r public sewer?
Y /0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y'
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# 02_Vl`/-7%(6 r C4>-
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y / N ( F
Permitted as: %�V'� Eu_ea t , ! oW; e( f-oe �5
Under Section: ✓ 7�J
Supplementary regulations section:
Parking formula:
e Y_i5 t�I� P k'`��
Required spaces:
qv((N -e
Y/N
Items to be verified in the field:
Viola ' ns:
Y /'"I
If so, ist:
Proff
Y N_�
If �t:
Var' e:
Y /�
If so, ist:
Y N
f so, List:
to
6/Ct76
- 67
Clearances:
2 v Q
15!7 2e16- S��e-�c�
SDP's
Lq to Albemarle County
nmmitnity (ut.vnlnpment Department
Application for Zoning Clearance
CLE # _,_7mR
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date:
Receipt # T1 Staff:
PARCEL INFORMATI N
n
Tax Map and Parcel:
^ ^ Existing Zoning
Parcel Owner: fff 61Crc � �G iNs / T35 Tye -
Parcel Address:-2IS/�oX old_ lP_hc,I_ CityState VA- -Zip 2,--4'dj
(include suite or floor)
PRIMARY CONTACT 150
Who should we call/write concerning this project?
Address : 2,2 / S City( State �g Zip 2-Z-g°I
Office Phone: ('f)�-`i s U7 Cell # -�4 �s� �'ei Fax # E-mail µ,be,�ri�e prEiel�ff
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
�
Business Name/Type: l�la2
Previous Business on this site 41-1111
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: /t/1-4-
*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 Printed i57 h �(
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 Date
Zoning Official Date l
Other Official V o � Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/1/2015 Page of
_�` 2 e0 - 'l L16 T Revised 11/1/2015 Page 2 of 3