HomeMy WebLinkAboutCLE201400163 Legacy Document 2014-08-2909- 21/2014 13:39 4349790341 CARTER MOUNTAIN ORCH PAGE 02/02
.A ppheation for zonxn Clearance
CLE # Za ! q - )
PLEASE REVIEW ALL 3 SnEETS I Check #
liecei L:
PARCEL INFORMATION
Tax Map and Parcel- 0 CC yi
Parcel Owner:
.WAI
Staff:
Existing zoning A-A _
VN Wlhuls
Parcel Address: � J l �j�i,(J P(• city- State
(include suite or floor)
PRIMARY CONTACT --
Who should we eaWwrite concerning this project?
Address :� On
Office )Fhone: C__) CeR* VAX #
APPLICANT INFORM[A,T :ON
Check any that apply: change of owmershi Chalage of use
Business Name/Typc:
Previous Business on this site
V zip 7
State zip��
lE -malt ci,��
- - Oath 064aa
of name New business
vk 41 /-23 // ki C
Describe the proposed business including use, number of employees, number of shift9, 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-
1 bcrcby ceriiry that i own or have the owner's permission to use the space indicated on this application. 1 also certify that the'informat on provided
is true and accurate to the best of my knowledge, l have read the conditions of approval, and I understand that, and that I will abide by them.
Signature
Printed
APPROVAL INFORMATION
f7l Approved as proposed [ ] Approved with conditions [ ] Dcnied
[ ] 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,
[ ] "Phis site' complies witb the site'olaa as of this.date.
i`Tbtes;
Building Officiaa Date (`(
Zoning official � Date
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
Intake to complete the following:
Y //1
Is use- n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / tt
Will t sere 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
Reviewer to complete the following:
Square footage of Use: Jam— Vb ce
V/ N. IJ
Permitted as:
Under Section: pAN L�
Supplementary regulations section:
Circle the one that applies
Is parcel o rw � we•11 or public water?
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 applies
Is parcel on sep is r public sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Parking formula.
Required spaces:
Y/
Items to be verified in the field:
If so, obtain proper
Inspector ; Date;
Notes:
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Viola ions:
Y /
If so, ;st:
Proffers;
Y�
If'; List:
Variance:
Y
If so, ist:
SP's:
Y/(�)
If so, List:
Clearances;
SDP's
Revised 7/1/2011 Page 3 of
08/21/2014 13:39
4349790341
CARTER MOUNTAIN ORCH
� j 2() I
fchvo�,
3 q - &d3 - 15(�-3
Ak Wg�
61/r �,Ajful�r �1L fCtc1�
r-? 0�- \ 7---
PAGE 01/02