HomeMy WebLinkAboutCLE201900012 Approval - County 2022-06-22tFFr;CVECi
County stnt``nt
p�m�p� ion for Clearance
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-s1S11� 1 t i;c CLE #
PLEASE REVIEW ALL 3 SHEETS
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CE S O LY
k # Date: -
Staff:
PARCEL INFOR ��jj mm �/ tt���� Pima
Tax Map and Parcel: 1yM9 a
Existing Zoning i'4J1
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Parcel Owner: AA Al 61 11 "1l' 111
Parcel Address:� 1Imb ' City , ► L State VQ'
It. Zip
(include suite or Boor)
PRIMARY CONTACT
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Who should we call/write concerning this project? J` �t�/} �Zi Ij] h 2�
Address �Cal " J lGI CCity State _ ZipzTi�f S
Office Phone: 0 S -3/� )�x#D E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership _ Change of use _Change of name New business
BusinessName/Type: /VIa�jS _-�1.Qjt4,dl.tt/
Previous Business on this site n
,
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:
*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 owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurate two thebestof my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signaturec� Printed )(f,/-�^�� �% 1 ►L P
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 I, 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 Date
ip
Zoning Official G Date Z- 15 —�
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 1 I/I/2015 Page 2 of 3
Intake to complete the following:
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Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
W iQl
it 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 ublic water?
If private well, provide Heat ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic or loublic sewrjO
Y Q
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y (( NJ
Willl t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
footage of Use: (00 t
N �
itted as: P4eo t�lt,i Offt"
Under Section: Z3 , Z, I r 2
Supplementary regulations section: r
hQ
Parking formula: l 12� FQ
Required spaces: /
Y / N 16
Items to be verified in the field:
Inspector : Date:
Notes:
Viol
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Ifs , tst:
Prof
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If so, ist:
VariMcce:
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If so, st:
SP'sy�
If //N st
If so, Est:
Clearances: 2ooG
2on5-SD - �!0 -243 2ev -c/`�
SDP's
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200?- 21g �2011 32f 2o12�
Revised 11/112015 Page 3 of 3
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