HomeMy WebLinkAboutCLE202000021 Approval - County 2020-10-05Application for Zonin Clearance
CLEk ;L- •,; pi i i;.
PLEASE REVIEW ALL 3 SHEETS CChe k # _
u� Date: IZ Zt?Lv
Receipt # Staff: n
PARCEL INFORMATION
Tax Map and Parcel: _ OStn &Z —o i _.Oil n t,, r' ZZOr7 Existing Zoning Dpw� A
Parcel Owner:_ Th i✓ . %I- rp L I
Parcel Address: 200 } l
5'-'$`r s ott:City State V Zip
(include suite or floor)
PRIMARY CONTACT
Who should wecall//write concerning this
� project?
Address : 37-7/([ (`�,0 gold— U
City L rU State A— Zip
Office Phone: ell # R Fax #
E-mail t_ S4p/%5
Check any that apply: '
_ Change of ownership _ Change of use _Change of name New business
Business Name/Type:
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts available arking spaces number of
v icles, and ny additional inf r anon tha you can provide:
:*:This Clearance will only be valid on the parcel for which it is approved. If y u 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 accura hcbest oy'my cnowled ve read the conditions of approval, and I understand them, and that I will abide by them.
Signature �TII_/L j / S
to Printed !moo>-m l�
AP OVAL INFORMATION
Approved as proposed [ ]Approved with conditions
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl Denied
[ ] 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.
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
Revised 11/02/2015 Page 2 of
Intake to complete the fol
Y/N
Is n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Yv/
Wit 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 or ublic wate .
If private well, provide Heal ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app ' s
Is parcel on septic or ublie sewe .
Y N
Wi u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wi 11�4te re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
to complete the
O
f � t l ► MI
Y
If
Y/
If sc
Reviewer to complete the following:
Square footage of Use:
ermitted as: ho�2�S, ��?(�S �lv%
Under Section:
Supplementary regulations section: ��-
Parking formula:
MD 11)60,
Required spaces:
Y
be verified in the field:
Inspector:
Notes:
SDP's
Date:
Revised 11/1/2015 Page 3 of 3
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