HomeMy WebLinkAboutCLE201700243 Application 2017-11-02Application for Zoning '� Clearance
CLE # 0 )\L)
04 AL$,
��RGIN'1P
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 111117 Date: iU• 3a
Receipt # 11114 110 Staff: f�Gzt e e
PARCEL INFORMATION 1
Tax Map and Parcel: �� -� Lo VA- 04 0A 0 Existing Zoning ( e� ��� fps(,
Parcel Owner:eAQV ACI k (� ` - UC-u_e_
Parcel Address:IL 1(m fA O 01-1 City ` A F1 6,kVdj..te VA ZiA��
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : Y.��� �� City StateAj� Zip
Office Phone: �O Z4 Cell # Fax # E-mail �l�[� Q 1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name--,,—^ew business
Business Name/Type:Em��oL_a_m
Eelo-i
Previous Business on this site
Describe the proposed business including use, number of employe , n tuber of shifts, available parking spaces, n mber of
v hicl s and any additional i rmation that you can provide:.€,��^Lr-�- l� (��I t�
*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. 1 also certify`that the information provided
is true and accur to to the best of my knowledge. I have read the conditions of approval, and 1 understand them, and that I will abide by them.
Si re Printed��(�n��
APP OVAL INFORMATION
[ pproved 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
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
I
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi 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 ublic 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 o 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: 10 b' ft Z
Pted as: (01 n d V S6
Under Section: Z,S. 2• 1 6
Supplementary regulations section:
Parking formula:
y 7s/1000 fj (S�Opn)n(n (c4),;)
Required spaces: I
It (/ No
�
Ite tbe verified in the field:
Inspector :
Notes:
Date:
Vio s:
Y/N
Ifs ist:
U 1 ^ a 1
Pr s:
Y/N
If so, nst:
V ar�ce:
Y(IN
If s�nst:
is:
fYJN
Aso, List:
ITS Z— SO
I S-L— S6
Clearances:
Zlrl) 7-0'1
U i7— 1821 in, Inn It6,Iz3, 7%
SDP's
lq�q—Is1
�tios- 17
Zc,6 � ZSS .1tig , '12(j ibl , 160
)
Revised I I/1/2015 Page 3 of