HomeMy WebLinkAboutCLE201400217 Legacy Document 2014-11-26Applicati ®n i ®r Zoning Clearance
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I' /1N;IN�r
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION -.
Tax Map and Parcel: (0 ^— 0 Existing Zoning f�Ct� y� pJ
Parcel Owner:
Parcel Address: City State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? T> Ao TA- r-AC -f—
Address : (¢sl City 'G'y , �� -i- State U Zip22q
Office Phone: (_� Cell # i_S Z11Z-7G(a5FFax # E -mail b PCAVu.4rc- 6DV,,a•t4-, wk--
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: y L i F'6
Previous Business on this site I.j i-
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: k 6 �g I>?_%.u4;Z7 tD �0 1j p1 V
-7 7i- M — ! r✓+
*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 kno ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature _ Printed Ay C
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 11 (� I
Zoning Official /'/,./ Date /l _�,_;e7/Zo/ y'
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
Intake to complete the following:
Y /6
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will ere 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 applie
Is parcel on private well o ublie w er?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app.l�e
Is parcel on septi or public se r?
& N
Will you be putting up a new sign of any kind?
Sign permit.
Permit # P ��
If so, obtain proper
Y/N
Will there 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: zj 0 60
/N
ermitted as:
nlp�t7•
Under Section: A\I,an. .prAc+iQ"Q'
Supplementary regulations section:
Parking formula= -
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
5oV'lations:
N
If so, List:
Proffers:
/N
Tf so, List:
Variance:
®/N
If so, List:
SP's:
`Y /NO
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page of