HomeMy WebLinkAboutCLE201400144 Legacy Document 2014-07-30, 1J
• o •
Application for Zon] Clearance
OF �ll.U�t
�lz`,
CLE # Z )
,. r
1 � � / /ifllt��r�
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # C4 sl^ Date: 256 1
Receipt Staff:
PARCEL INFORMATION
Tax Map and Parcel: U-2 Existing Zoning
i f`
Parcel Owner: am) L. L C
�+ /1 �° 1r
Parcel Address: 60V ��,� &L �'j, City � �9i� C. State Zip • 1
(include suite or floor)
PRIMARY CONTACT
Desw ct,&
Who should we call /write concerning this project? Gty'\
Address: f,00 K�1 wt City cy, (l State Zip12i OJ
a
77
Office Phone: (� 11 � Cell ' y Qx # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
1
Business Name /Type:
V
Previous Business on this site D ^C; Use,
Describe the proposed business including use, number of employees, number of shifts, a ailable pa king spices, numb, r f
vehicles, and any additional information that you can provide: ,U D•
prfy S li °Q1 �eJ Ga i1
*This Cle ante will only be valid on the arcel for tvfiich it is approved. If you change, ntensify 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 he best f my knowledge. I have read the conditions of approval, and I understand them, and that II will abide by them.
Signature Printed t
APVAL 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
� —��-
Zoning Official Date',�ta
Other Official Date
County of Albemarle impartment of Community lieveiopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
CA)6\
V '
L
Intake to complete the following:
Y /
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /(S)
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 or (public watu..
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app '
Is parcel on septic or ublic
Y /�
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /(&
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to complete the following:
Reviewer to complete the follco�wing•
Square footage of Use: b (d �9
Permitted as: &Vilr
Under Section: 01 �,. d . 1 , (C7
Supplementary regulations section:
Parking formula: i " -ra I
Required spaces:
Y/
Ite o be verified in the field:
Inspector : -111r Date:
Notes:
Violat'ons.
Y /(�I�
If so, st:.
Prof
Y/N
If so, ist:
Var ce:
Y/
If so List:
,
SP'
If.s Nist:
Clearances: '� E 16 ,� 5
l�
/SDP's
(�
Q1
Y
Revised 7/1/2011 Page 3 of 3
Ile,
Z11-11
0<11
4c),
Ja
Ile,
Z11-11
0<11