HomeMy WebLinkAboutCLE201400176 Legacy Document 2014-09-09Applicati ®n f ®r Z oning ClearanceEl�
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 14 Z 1 Date:
Receipt# �itnQ9 3 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 00 Existing Zoning 1�a L'4*%V dMftV_i i
Parcel Owner:
(i5 n (
Parcel Address:(, I V .FX1S�L0,/j'lo f �LCity State Zip �-
)9,t3clude suite or floor
PRIMARY CONTACT --'
Who should we call /write concerning this project.?
Address: b ' "`-” 1L��/�.1 -City CCA&wlt t � State Zip'�OY2
Office Phone: �) Cell # 7 �' 6a # E -mail
APPLICANT INFORMATION
Check any that apply: _Change of ownership Change of use Change of name ew business
1�
Business Name /Type: �L'n 1, 4A
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: — ,e1 O
*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 t own or have th wner' r • sion to use the space indicated on this application. I also certify that the information provided
is true and ac rate to the best of y kn d have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROV IN O 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 � __3bl-k
a
Zoning Official Date �! �ly
Other Official Date
County of Albemarle Department of c:ommumty 1ieveiopment
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 /)
Is use in LI, HI orPDIP zoning? Ifso, give applicant a Certified
Engineer's Report (CER) packet.
Y Y/N
ill 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 water
If private well, provide Hea th Depa ent form.
Zoning review can not begin e receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic o public sewe .
Y
Wil be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Will We be any new construction or renovations?
If so, obtain the proper Permit.
Permit # &S6 1) e.
7,oninfy to complete the followinLi:
Reviewer to complete the following:
Square footage of Use:
iY)l N L
``PP rmitted as: _IIT'ic� r'R
Under Section: �G%. 2 • I
Supplementary regulations section:
Parking formula: '/7
lad pn
Required spaces:
/N
Items to be verified in the field: {{
l� �r✓�Qi N3
Inspector : Date:
Notes:
- - - - - -- -- - - - - -- -- - - - -
Violations:
Y /If
If so, List:
Proffers:
Y /(I�
If so, ist:
Variance:
6/N
If so, List:
SP's:
0/N
If so, List: ,
Clearances.
SDP's
Revised 7/1/2011 Page 3 of 3
AL