HomeMy WebLinkAboutCLE201200261 Legacy Document 2013-07-26k
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Application for Zonin C1 . rance�`'
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE QNLY
Check # W-1- — Date: / /�i/ 9
Receipt Staff:
PARCEL INFORMATION
Tax Map and Parcel; e� 7�?00 ^t,-i -z " Existing Zoning
I
�0 f t�'✓ xy
Parcel Owner:. V (
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Parcel Address: City M16 L tnte. L"71 Zip f
(include suite or floor)
PRIMARY CONTACT ����
C 5
Wya e- /�
Who should we call/write concerning this project?
Address: ���J� �T `'r' Gr�O 4z City 6isaaAg!/� State \rL Zip
Office Phone: (�( Cell # `6 5oi93 Fax # H99M 7-2LOE -mail I i t PY OW'] I [,A
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APPLICANT INFORMATION
Check any that apply; Change oofdownJerrssh�ip Citange of use Change of name New business
BusinessNametrype:
Previous Business on this site
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 wh €oh it is approved. If you change, intensify or move the use to a new locat €on, a new Zoning
Clearance will be required,
I hereby certify that I own or have the owner' permission to use the space indicated on this application. I also certify that the €nformation provided
is true and accurate o the best ofm ge. I have read the conditions of approval, and I uu der�sttaaand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
Approved as proposed ( ] Approved with conditions ( ] Denied
[ ] Bacicflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] Na 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 1r✓ Date
Date
Other Official
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
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Intake to complete the fallowing:
Is/
Is u n LI, HI or PDII? zoning? if so, give applicant a Certified
Engineer's Report (CLR) packet.
VVN
there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until Nye receive approval from Health
Dept. FAX DATE
Circle the one thWap lies
Is parcel on ofivate well}}'' public water?
If private well, p i'fealth 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 or public sewer?
( N
I1 you be putting up a new sign of any ]rind? If so, obtain proper
Sign permit,
Permit #
i / N
ll there be any new construction or renovations?
If so, obtaint:e�r�peZ�� it�
Permit V G
Zoning to comniete the fnllnwing:
1
Reviewer to complete the following:
Square footage of Use:
N ��
Permitted as: ; ;]() I-rj
Under Section: )-2.2 •!
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspectors Date:
Notes:
Vlot tf ns:
Y
If so, ist:
Proffe s:
Y /`�
If so, List:
ariance:
/N
If so, List:
P's:
6./N
If so, List;
r
' e� -/
Clearances:
SDP's
Revised 7/1/2011 Page 3 of