Loading...
HomeMy WebLinkAboutCLE201400121 Legacy Document 2014-07-02Application for Zoning Clearance CLE # 2—O I LI ^) 2.1 � %1iGlN�P OFFICE USE ONLY Check # CgSL, Date: l0 2 j PLEASE REVIEW ALL 3 SHEETS Receipt # 6) s 9 Staff: PARCEL INFORMATION 95-WA / F>16 Tax Map and Parcel: Existing Zoning r) nPLL Parcel Owner: Otf' -'o a '5 Parcel Address: 19 *0 0 �j G cl N City C+N a State V A Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? 0 �l I�-1 y A �'!� Address: p e�t WL City ©� Q V1 :l° State Zip Office Phone:( `) �� Cell #�'I' Fax # E -mail a rjq, APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: J / a 7 Tj s 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 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. I also certify that the information provided is true and acc rate to the best kf my kn wI ge. read the conditions of approval, and I understand them, and that I will abide by them. Signature Printedy g .. APPROVAL INFORMATION Approved 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 r Zoning Official Date V_'?61z_y� 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 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/N Will there 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 puZblic-wat7e If private well, provide Hea ent 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 ublic se r? 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: d/N Permitted as: Q. Vo� Under Section: ri7M Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y/N If so, List: Proffers: IbIN If so, List: Z/'.►� 2oo.r � Variance: (2)/N If so, List: O � q SP's: &/N If so, List: Clearances: SDP's 3 �d12` t) 2 Revised 7/1/2011 Page 3 of 3