HomeMy WebLinkAboutCLE201500094 Application 2015-05-19pv .ri.ufyc
Application for Zoning Clearance i�=��,:
CLE # �.C� S � 00 0 .r.
OFFICE t 1'
PLEASE REVIEW ALL 3 SHEETS Check # Date: ,
Receipt # Ong Staff':
PARCEL INFOR �[A� I v 1 �1 I
Tax Map and Parcel: nt "Y Existing Zoning
parcel Owner:M ( i,(� ' L �+
Parcel Address: 1635 f3��a�a�. QfLC4f. City l_.LkP^L0`iVCL46tate V� Zip���1
(include suite or floor)
PRIMARY CONTACT' p �
Who should we call/write concerning this ro, ect• v
uLULState V14 Zip ZZ-zos
Address: �D d � 6 2$ City S+�IA S
Office Phone: d" 249 Y2(I Cell # A/JY fq&'/2l( Fax # kA E-mail 9LSO
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:
Previous Business on this site
Describe the proposed business including use, number of employees, nnuuumbersS ift�aaailablleeLparkn g spaces, number of
vehicles, and any additional information that you can provide:
*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 I understand them, and that I will abide by them.
Signature l•- Printed 14:FFCL£Y L - a'EaP-W
APPROVAL INFORMATION Denied
] Approved as proposed [ ] Approved with conditions [ ]
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ ] 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
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/l/2011 Page 2 of
Intake to complete the following:
Y ./
Is use m LI, Hl 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 applies
Is parcel on private well Tic water
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 septi or public sew r9 �
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit,
Permit #
Y
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: A o
Ier
/N
mitted as:�i
Under Section: 2S id.
L I
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Zoning to complete the followin :
Violations:
Y // A
Ifs ist:
P rs:
Y /
If so, List:
Vari ce:
Y/9N
If so, List:
SP's:
Ifs ist:.
Clearances:
SDP's
Revised 7/1/2011 Page 3 of