HomeMy WebLinkAboutCLE201500103 Action Letter 2015-06-03lV' 11.1/f�
Application for Zonin Clearance
CLE # 'DO1 S — 10 r
OFFICE USE ONLY 1S
PLEASE REVIEW ALL 3 SHEETS Check # �(10.51n Date: S "
Receipt # 1V19 D, Staff:
PARCEL INFORMATION _Bxistirrg Zoning
2/
Tax Map and Parcel:
Parcel Owner: '�;� /� p S __�__ ('� �^ ¢ �✓ O��l1""
Parcel Address: J �%J J1�SJ�l�r �`C City S State v A Zip )'2,7,/
(include suite or floor)
PRIMARY CONTACT _
Who should "p
wPecall/write concerning this project? t%
Address
? "f 7 J c>i� i �� City ., , C_ State ll Zip L1
Office Phone:
( ) —)°fig Cello �"7' l Y 3Fax
i 0 Gehl
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:c-
Previous Business on this site✓t�
Describe the proposed business including use, number of employees, number of shift , available par ing spaces, number of
vehicles, and any additional information that you can provide: P lino z� [ -meas
*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,,be t of my knyaa¢edge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
-[/ Printed
EVOVAL INFORMATION Denied
A pproved as proposed [ ] Approved with conditions [ ]
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x1 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:
r--
Building Official Date 2-1 t�
Zoning Official Date (l
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 / IO
Is use in LI, H] or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Will sere 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 R
Is parcel on rivate w�,Iealth
r public water?
If private well, ro-7td Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one applies
Is parcel o septic r public sewer?
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 construct on or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the
following:
Square footage of Use:
I✓ / N `
Permitted as: nn
Under Section:
Supplementary regulations section:
Parking formula: 11 Am
rsa I , 6-D 5�&
Required spaces: J ` V`�' � V�� )
Y/N
Items to be verified in the field:
Inspector : Date:
Notes: " 1dlJ; b
Zoning to complete the following.
Violations: Pi °
Y /� Y N
If S/ st: If s ist:
Var' • ce: S 's:
Y/N Y N
If so L st; so, List: �0 t
Clearances; _ elk�� J m SDP's
WIN
Revised 7/1/2011 Page 3 of 3
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