HomeMy WebLinkAboutCLE201900052 Approval - County 2019-05-22Application for Zoning Clearance
CLE # 2DO(�
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date:
Receipt # ll ( ,� Staff:
PARCEL INFORMATIO G/J.,, as ,OD , D� l-
Tax Map Parcel:
and Existing Zoning p
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Parcel Owner: L
Parcel Address: eZ--�p G� City Zi
C/lO��O 0/ 65ylyt/aQ$ {/
y p 6&
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: CP /5
Office Phone: 7 # Fax # sE-mail Q
(✓�j�' ell jj
APPLICANT INFORMATION c aMrnCrc
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 4(frSk/% �— ��d a _
Previous Business on this site-5e/-) l e2 '6? �a 2�0
Describe the proposed business including use, number of employees, number of shifts, availabl parking spaces, number of
vehicles, and ny additional info r tion that o can ovide:
._ r, �.
*This Clearance will only be falid on the parcel for which it is approved. If you change, in ensify 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 hat I will abide by them.
Signature Printed X� r11y,,, s 7
APPROVAL INFORMATION
Approved as proposed ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, xl 17.
[ ] 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 DateVz
Zoning Official Date S
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 11/02/2015 Page 2 of 3
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Intake to complete the following:
Is /
Is u n4e�i LI, HI or PDIP zoning? If so, give applicant a Certified
Engine% 's Report (CER) packet.
Y /
Will )re 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 oirpublic w
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 Zrp�nbl:ic
Is parcel on septic�sewer??OIN
VN
you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will ere 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:
I i ted as:VV
Under Section: I �,
Supplementary regulations section:
Parking formula: �,
Require; paces: ;
Y / N,-'�'
Items to be verified in the field:
Inspector :
Notes:
Date:
Vio ns:
Y N
If so, ist:
Pro
Y /
If so, 171st:
Var• e:
YA
If so, ist:
SP's
Y'O
If so, List:
Clearances: Q
SDP's a q
Revised 11/1/2015 Page 3 of 3