HomeMy WebLinkAboutCLE201400134 Legacy Document 2014-07-23Application for Zonin Clearance
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OFFICE USE ONLx J t 7 /
PLEASE REVIEW ALL 3 SHEETS
Check # ) (O Date:
Receipt # Staff:
PARCEL INFORMATION
Tnx Map and Parcel: 061 WO -01 -OA -00700 Existing Zoning C -1
Parcel Owner: Virginia Institute of Autism
Parcel Address: 3500 Remson Court City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call /w Ite concerning this project?
' State f , Zip
Address:_ IYI QIL:f�A—t_ City.
Office Phone: (� !VL�ell # Fax # Q'Qal EML&-mail v 'tyJ ►A G
APPLICANT INFORMATION
Check any that apply: ✓ Change of ownership Change of use Change of name New business
Business Name/Type: i
Previous Business on this site CX-
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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand diem, and that I will abide by them.
Signature %�"o K. Printed
APPROVAL INF ATION
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 `t k S i C
Zoning Official Date 7Z /5j ZoAJ
Other Official Date
County 01 A.loemarie uepartmenr of uummunuy Lcvc,vN,,,u„�
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax. (434) 972 -4126
Revised 7/1/2011 Page 2 of
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Intake to complete the following:
Y/N
Is use in LI, HI orPDIP 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 publi wn r?
If private well, provide Hea ment form.
Zoning review can not begin until we receive approval from Heal. th
Dept, FAX DATE ,t
Circle the one that applie
Is parcel on septic or �blic sewe
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 #
r7 --.' -- J.- --- .,1 „4„ +l,n fnlrnwf"n.
Reviewer to complete the following:
Square footage of Use: I I , SrD 11,
YJ/ N•'
Permitted as:
Under Section: •2
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N 77
Items to bq verified in the field;
Inspector : Date:
Notes:
,FJV11111 LV W111 1G {.G Nw awavnau
Yioons:
If so, List:
Proff.�rs:
Y /(Y
If so, List:
Varii ce.
Y It
If so, List:
SP's:_
Y
If so, List:
Clearances:
SDP's
D� 2�
G s -2y
Revised 7/1/2011 Page 3 of 3