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HomeMy WebLinkAboutCLE201500138 Application 2015-07-29Application for Zoning,Clearance ;s Jit'lllil' �? CLE # �O �s _ Iia=�_... '7HcAN�r PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check# 5xi I Date: Receipt # j (90 Li `'I Staff: $QZ. PARCEL INFORMATION f! Tax Map and Parcel: ©12p0- oo- L90—U019.4.7— Existing Zoning 1--,101�� Parcel Owner: �/!'IA)7-es Parcel Address: lwl. 66 a jeex, l ICLe/1 City -/4sy,'&State �� Zip (include suite or floor) PRIMARY CONTACT 6/Li9T%itt"' Who should we call/writeeconcerning this pr_ojeect? CT/ ,/ 9 Address : Z/ /Ql,�nUJ �OG(- City `7�v1%2I/y State V Zip(iy Office Phone: SD 295 =4 U0Cell # 904%-f&4#`,0Fax # E-mail a,/ ajea ►/lYylhle�Gfr�rn la«,nCG-cam. U APPLICANT INFORMATION Check any that apply: of ownership Change ofuseChange of name New business ' /Change /4aC-V, Business Name/Type: 4-l V PreviousIf Business Business on this site Sucyc-Pe:i, Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: rd✓ r.Le �' ii1 !/ �e�A, ll,.✓ry1 Ps-1�Jens ,� ,rZ4 i W, h u.-f Cz,,P( enoen el s- d-., e *This Clearance will only be valid on the paYcel 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 knowledige. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed LTAZ P­ APPROVAL INFORMATION '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 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 7/1/2011 Page 2 of 3 Intake to complete the following: 0/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/6N Will there 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 o public Ovate ? If private well, provide Heat ment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies -7:.. Is parcel on septic o 1c sew 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 construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: � Dyb /N ermitted as: �f aY►� �. Under Section: Supplementary regulations section: Parking formula: J sf Pe t') 1D Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violati ns: Y/ If so, List: Proffers: Y/(I) If so, ist: Varian e: Y/J If so, List: SP's: Y/ If so, ist: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 1v 5 �izolto-