HomeMy WebLinkAboutCLE201500112 Action Letter 2015-06-11Application for Zoning Clearance
CLE# 2-61S- i)I
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Checl< # J77 () Date;
Receipt # l 000">9 Staff:
PARCEL INFORMATION
Tax Map and Parcel: ;'9 �6 -- _ M13dExisting Zoning
Parcel Owner;
W.
Parcel Address: S7l 7he'ee &T City �I�`DZp7— State
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
City C (CD 7,,?—f-- State y A Zip �.
Address
Office Phone;
--�i Cell # Fax # E-mailP I1 f9'1(S CO f'►'1
APPLICANT INFORMATION
Check any that apply: Change of oh
Business Name/Type: LX02C7
Previous Business on this site
Chancre of use
� 1 -LC -
Describe the proposed business including use, number of employees, number
vehicles, and any additional in ormation that you can provide:
5�►i;�-
Change of name _New business
available parking spaces, number of
*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 accurst to the best of my knowledge. I have read the conditions of approval, and I understand them, andel that I will abide by them.
Signature Printed - e
l
API�ROVAL INFORMATION Denied
[ . Approved 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:
Building Official Date GI i
Date
Zoning Official
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 7/1/201 1 Page 2 of 3
Intake to complete the following:
Y usn
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi iere 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 )ublic water,
If private well, provide Hea 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 ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.. ff MAS f
&��
Permit #
Y/N
Will there b any new construction or renovations?
If so, obtain the proper Permit,
Permit #
Reviewer to complete the following:
Square footage of Use: 1100
Y)/ N
Permitted as:
Under Section:y`�� • 7! �l 1
Supplementary regulations section:
Parking formula: 1'1 Oki
Required spaces: in
Zoning to complete the following:
Viol ns:
Y N
If so, st:
Prof '.
Y/ IN
If so, ist:
Nil -1e:
Y/
Ifso,t:
SP's•
Y/�
If so, ist:
Clearances:
SDI's � 1
Revised 7/1/2011 Page 3 of
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