HomeMy WebLinkAboutCLE201500124 Application 2015-06-24Application for Zoning Clearance's
CLE # Q) 'S - J 2:
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check# 1'7- 9 1 Date: z))
Receipt # 100 t 17 2 Staff:
PARCEL INFORMATION �J �n
— % ( Existing Zoning N Vtin
Tax Map and Parcel: !
Parcel Owner: M1&VIaei Ci. V-tAIn&QC HZly)GOLy- /Eyigzl AVL
Parcel Address: qH I &WW00 A S; W1 o yl ��city c�1 aV l01te5 ✓I 1 1-f— State V✓al Zip z- ' a
(include suite or floor)
PRIMARY CONTACT 1
(Vi (AGS 6'-2 s G) �S
Who should we call/write concerning this project? 1 Gil aQ� �I GIVI 1
Address: G7Vn\A/00 d ✓1 city C�iayio-H"e&0 I le State VA Zip 2mol
Office Phone: (4-D) 220 .x(01 ( Cell # Fax # ` S4.2.2U • 4 (°1E-mail YVI1 G�IG(�� • S• h A n Gof�k A �'✓� p F
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: �+Aylwa_ +�IVIQI loa l �O!&e
Previous Business on this site K b IV V
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
WSJ VU
vehicles, and any additional information that you can provide: 12 P Ml 10.e iI Nt11EiA 6 V L(XVIC460 CtA Vi ce-
eavV4vii W 1 4r bu51 Y1C��5C5 0 5 lv v�ln� d e l us vty c l l en 13 I l'ta� C oov+c.
v` ars m �h
;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 pmmission to use the space indicated on this application. I also certify that the information provided
is true and accurate to e best of my knowle e I have read the conditions of approval, and understand them, that I will abide by them.
�and
(I�
Signature Printed I (U 1 G�
APP AL INFORMATION
] ppro .ed as proposed [ ] Approved with conditions [ ] Denied
[ B flow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ o 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 (S S
Zoning Official LIA 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 7/1/2011 Page 2 of 3
CSA
55
Intake to complete the following:
Y/NO
Is use to LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Reviewer to complete the following:
Square footage of Use:
9/ N
ermitted as:
Y /h � �
Will `there be food preparation? Under Section:
If so, give applicant a Health Department form. i
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one thatapplies Parking formula: n ti
Is parcel on private well or public wa (�
If private well, provide Hea rtment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
IIN
Circle the one that applie Ite be verified in the field:
Is parcel on septic or blic s er?
Y/
Wil o, Y
u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
��� P
,� B,
Permit # Y �j Inspector : Date:
Wit
Notes:
Will\l eeere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Znninsr to cmmnlete the following:
Vio s:
Y(/N')
If s , st:
Proffers:
/N
Pso, List:
c -n
Variance:
Y /nN
If sl3ztist:
SP's:
Y/N
If so, List:
Clearances: � � 1�
SDP's
L
Revised 7/1/2011 Page 3 of 3
N
Z
CLS