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HomeMy WebLinkAboutCLE201200155 ApplicationApplication for Zoning Clearance CLE# �biZJ% ID- PLEASE REVIEW ALL 3 SHEETS OFFICE U G NLY Check # d Date: _ ~ d o' Receipt # Staff: PARCEL INFORMATION ii + nn U% C, V �O J Tax Map P. H L and el: J Existing Zoning , / ��O_D_T Parcel Owner: ALA i"1L►r.) S Parcel Address:_" 165 je.), `I'~�­T�?kf. City C_ IV" I State W4 ZipgMO (include suite or floor) PRIMARY CONTACT 66-r Who should we call /write concerning this project? � 01 � R2, 1 Address: J 1rtJ 111. �^ Q��q�O City 0 V ` State Zip C Office Phone: (`�3q) -5��-' 415 (© Cell # t Sr ( SOS Fax # E -mail 34,6ffft)(X W W+.APQ& APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: 1j4-1 1C.+ �J ) I i� L • ' bGI- 1,05CA ia�_ CDQ-rizlq <--rI A11, 4 -b Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available par ing spaces, number of vehicles, and any additional information that you can provide: L-Aw P_,_,Cr\pj_ CD, LID Q vi a jeW L 1 ;24Q,4(14 *This Clearance will only be valid on die parcel lbr. 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 c •tiff that I own • have the o� er's permission to use die space indicat d on its application. I also cert ily that the information provided is true a, a to to the b st �my know dge. 1 liave i the conditions of a roval and I under, tan then an that I will abide by them. Signature t' Printe �'� h -ri��l f�,S APPROVAL INFORMA ION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backilow prevention device and /or current test data needed for this site. Contact ACSA, 977-4511, x1 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 `I L°� t Zoning Official , Date ���d�� O% V- J 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 7/1/2011 Page 2 of 3 11 �+ s' e_. _S 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 / Wil sere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval 'Prom Health Dept. FAX DATE Circle the one ' - s Is parcel on rivate well or public water? If private we e Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one applies Is parcel of CV or public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit# Ibil , Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonina to comDlete the following: Reviewer to complete the following: in Square footage of Use: �► / t✓ 2,(// N Permitted as: Under Section: Ly• 2 •' Supplementary regulations section: (��� Parking formula: Required spaces: Y/N Items to be verified in the Field: Inspector : Notes: Date: Varia e: Y/0 If so, List: SP's: Y(f� If S'6-'4A 't: Violations: 6/N If so, List: P offers: 8/N If so, List: Varia e: Y/0 If so, List: SP's: Y(f� If S'6-'4A 't: Clearances;,..-- --,... - SDP's Revised 7/1/2011 Page 3 of 3