HomeMy WebLinkAboutCLE201400181 Legacy Document 2014-09-18Application for Zoning Clearance
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CLE # �t7�� 181
OFFICE US
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATI N �p
9n 2-1 A
Tax Map and Parcell:' Existing Zoning
Parcel Owner:
Parcel Address: _Wys- o �grP _ T�CA(_ CityC�gpe jc& Ie_ State ,,Vk Zip 7-Z 96 %
(include suite or floor)
PRIMARY CONTACT f y�
/write this
Who should we call concerning project?
Address : /1'y- City 5U(Clre State V L. Zip 229'o.-
Office Phone: V 2�3?450.1 Cell hkX�p, 3_&oy Fax #fi90293 S16r E -mail ���t+ �`� ���� �e %�l► r+s
APPLICANT INFORMATION
Check any that apply: Change of ownership of use —Change of name New business
/Change
_
Business Name /Type: VQ.G /.v .
L '"`_O' cro!�6
Business
Previous on this site 7, l-, ►
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 provider A Y j"A1 -5 QMVO
*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 understand them, and that I will abide by them.
,II
Signature e^L Printed
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 ! f f f
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 3
M_
Intake to complete the following:
Y /(O
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
rn 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
Is parcel o private wel or public water?
If private we , pro ealth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the on 3 applies
Is parcel o septi or public sewer?
Y 0
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y /
Will ere 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:
Y/N nn
Permitted as: l'A %il
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol 'ons:
Y /qNN
If so, ist:
Prof rs:
Y/ 1
If so, List:
Variance:
%/N
If so, List:
P's:
/N
If so, List:
3
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3