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HomeMy WebLinkAboutCLE201900023 Approval - County 2019-05-22Application for ZoningClearance (Zoning 23 OFFICE E N Y PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORM O Tax Map and Parcel: - 4 Existing Zoning Parcel Owner: ��// ' / Parcel Address: g4t)(5 TV warn t"olS City ar a V State VA Zip (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? LCA9_11 r'-�{�l^ j,�i MA'r . Address : 0Y'i6© I V � �rn YYl Q�'% S City a 5V11 �/ State i ZipO w . Office Phone: "t( 3q �QP�j • q(47ell# �3yy roti-cXKFax # g3q.265 q -mail � .� 1 Irv[ v6(ab 1 l . ccwt APPLICANT INFORMATION I vP Check any that apply: Change of ownership J Change of use Change of name New business Business Name/Type: 1 okw'Iua,n Previous Business on this site (C 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: I r '/' h + cal - vc o o U 'n" *This Clearan e will only be valid on the parcil fibr w ich it is approveA. 4f you change, intensify or move the use o a new location, a new Zoning Clearance will be required. I hereby ce own or have the ovine ' ermission to use the space indicated on this application. I also certify that the information provided is true an accurate tj the besLof my know edg . I have read the conditions of approva nd,^ I��u�,n"^derstand therm, and that I abide by them. )w-ill QSignature Printed [k l Y�l 0.1 MA'r- � 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 OZ�I Zoning Official Date 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 / 112015 Page 2 of 3 Intake to complete the following: Y� Is usLin LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y N 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 or public water? 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 public sewer? 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 complete the following: Reviewer to complete the following: Square footage of Use: I 5ZS Y/N Permitted as: &7L j Under Section: .� . (bi.1) Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Viol ns: Y( Ifs Est: l2 6-W Proffers: Y/N If so, List: riance: Y/N � If so, List: qa0� SP's: If yelst: Clearances: SDP's q` �- 19Rq - i a()() q ace - -7 3y Revised 11/1/2015 Page 3 of