HomeMy WebLinkAboutCLE201500004 Legacy Document 2015-01-14Application for Zoning Clearance
CLE# 7—())6--1
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # 253 Date: o f 0 & l 5
Receipt # q .0 Staff:
PARCEL INFO TION
Parcel: I )o no 1 �`'i
Tax Map and , Existing Zoning
Parcel Owner: I /J-5 i L
f�
-
Parcel Address: � T V , —FM�l_,i role City oft State NiA Zip �V
J
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Fn lea Xf
Address: Lo �W r ity 1 l State Zip
Office Phone: QCell # Fax # l -mail `k 111, Clam 10', M-,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: A_f 1 ^l r Uf / ) F�))ya�e
Previous Business on this site cavGler -hrc I rn and i11deQ2 ycGr 1�1
Describe the proposed business including use, number of emplo ees, number} f s available parkin s aces, number of
information that
vehicles, and additional you c n provide:
on i
*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 acc rate to the be of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature 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 r 4-, Date 1 �!
Zoning Official :° ( Date Z4azzioL
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
In
Intake to complete the following:
Y/16
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / `tIi
W i re 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 o —ubU at 0.
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 septic o ublic se er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
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:! �y
Y/N
Permitted as: d T A C (!
Under Section: 2.5•4.2 ` 1
Supplementary regulations section:
Parking formula:
Required spaces:
Y /
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y / N
If so, List:
Proff s:
Y /
If so, ist:
Variance:
Y/N
If so, List:
SP's:
Y /IV
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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