HomeMy WebLinkAboutCLE201500017 Legacy Document 2015-01-30Application for Zoning Clearance�ltl,.
CLE # � �. - l
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE Y ,��
Check # Date:
Receipt #tT�-W)Staff: obi
PARCEL INFORMAYION �j 1�
`2 ✓ 40 Existing Zoning L'
Tax Map and Parcel:
Parcel Owner: v oL 1dX
✓ �-U City t y Zip z
Parcel Address:_ i�ID,J U�V_State
(include suite or floor)
PRIMARY CONTACT n
Who should we call/write concerning this project? t
i
Ir�C ity 1�� �� �t�� ,�Vi � 1-9-Z.
Address:
# E-mail
Office Phone: (_) Cell # Fax
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
LC
Business Name/Type:
Previous Business on this site ry�b �- i c -n- 4r-) (6c—AaueaA�&,
Describe the proposed business including use, number of employees, number of shifts, available p rking spaces, number of
"
' ib � s '
vehicles, andany additional information t at you can provide:
—[6
*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 accMt to -the best of my knowledge. I ave the conditions of approval, and I understand them, and that I will abide b hem.
d
Signat,.rM&
APPROVAL INFORMATION
f] 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 ) t 1
Zoning Official Date 11���
Other Official Date
91Cg
County of Albemarle oepartmentof Communny iucvew1K11eBL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
/ Revised 7/l/201 1 Page 2 of 3
Intake to complete the following:
Y
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engi • er" Report (CER) packet.
Y N
Wily 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 or public w' r?
If private well, provide Hea ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that apls es
Is parcel on septic or ublic sew r?
Y N
Wil u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YN
Wi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy to complete the following:
Reviewer to complete the following:
Square footage of Use:
(S) / N p
Permitted as:,
Under Section:
Supplementary regulations section:
Parking formula: 77 hsC--,
Required spaces:
Y/
Items to be verified in the field:
Inspector
Notes:
Date:
lations:
aN
If so, List:
�bA�X
Prof�feerrs:
Y /lam
If so, List:
Variance:
616'/N
If so, List: 1
SP's
�l
Y/�J
If so, List:
Com] j
-
Clearances:
SDP's �G
Revised 7/1/2011 Page 3 of