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HomeMy WebLinkAboutCLE201900234 Action Letter 2019-10-18i yy Application fQr_ZQnin Clearance CLE ao�g- ._ .. �� .. OFFICE USY.,O}: PLEASE REVIEW ALL 3 SHEETS Check #`r Date: �� PARCEL INFORMATION Receipt Staff: Tax Map and Parcel: _ S(-jQ[ 2.— I ` Existing Zonin �1✓ g C D Parcel Owner: T(,P(# U T 1, �"1 � ` 1-- ' Parcel Address: 26�.Zr L1 `✓,Gl K;� N-Qo4jecity ��, �— State V /� Zip 2� (include suite or oort� ) PRIMARY CONTACT Who should we call/write concerning this project? Address Office Phone: (_) Cell # APPLICANT INFORMATION Check any that apply; Change of ownersh City State _ Fax # E-mail _ Change of use Change of name Business Name/Type: ale 4 'KJVI ' 1 Zip ew business Previous Business on this site moio Describe the proposed business including use, number of employees, number of shifts, available parking s aces, number of veticle's, and any additional that you can provide: eyy,- o y_e e, l , *This Clearance will only be valid on the parcel for which it is approved. If you change, intensity or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or the owner's permission to use the space indicated on this application, I also certify that the information provided is true and accurate t es' my knowledge. I have read the condi of approval, and I understand them, and that II will abide by them. Signature Printed APPROVAL INFORMA ON Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117, >-i4: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 (f���(o 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 111112015 Page 2 of 3 Intake to complete the following: Is Is u LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /t-tIf Wil 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 public w�ater?Ifprivate well, provide Heat i eprm. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or ublic 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: N � uttedas: bo/bey, 6�qv�7 S�,o S- Under Section: 2 © . 2— Supplementary regulations section: Parking formula: f -Z c2o Required spaces: Y / Ite be verified in the field: Inspector : Date: Notes: Viol ons: Y Ifs Est: Pone / v Prof s: y/ If s, //�st: /Vd-t Vari e: Y /�) If so, ist: Woie✓ 's: Y N so, List: c Q Z� (5 3� D I �r yL 12117(c Clearances: ego SDP's SD _ 2o1(a CL�- 701'1 3 D 22( 2 be 2012 1 r,le Z616 -Z05 le 2010 20 Revised 11/1/2015 Page 3 of 3 7 2oz� Lbw A✓�,,,.� Va- �c�z P-,eW SfvCCeii VA-