HomeMy WebLinkAboutCLE201500180 Application 2015-09-0908/0112015 09:43AM 434$231593 CHILES PEACH ORCHARD PAGE 01103
Application for Zonin � Clearance
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OFFICE USE O
PLEASE REVIEW ALL 3 SIIZETS
Check#
)Eteceipt # staff:
PARCEL INFORMATION
Tax Map and Parcel: o-,oo — —(1 1 Q 0o Existing Zoning
Parcel brunet LJl{ 1 [ �[dch 0 ,,[, 1 r Ike IJl b
Zipce
parcel Address: i %gmIt Rvaek city state V% —zip
(IncltWe suite or floor)
PRIMARY CON'T'ACT
Who should we call/write concerning this project`.'
Address : Ci State Zip
Office Phone; L.) cell 4 Fax # E-mail '
i?IIiV`x h fd . cv-,
APPLICANT INFORMATION
Check any that apply: Change of Ownership Change of use of name New business
�1_.Change
Business Name/Type: a f fir( � (firl I S Irlr'
Previous Business on thins site
Describe the propot3ed business including use, number of employees, number -of sbi ave"able rl�iung 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, intomsi l r or move the use to a new location, a new Zoning
Clearance will be required
I hereby certify that 1 ovm or have the owner's permissiou to use the space indicatd on this application,. I also certify that the information provided
Is true and accurate to the best of my knowledge. I have read the conditioos of approval, and I unders4=d them and that I will abide by them.
Signature Printed
AP MOV.AL INFORMATION
jf Approved as proposed [ ] Approved with oonditions j ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
j ] No physical site inspection bas been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ )This site comaplie's with the site plan as of this date.
Notes:
Building Official Date ft t (a
Zoning Of`idal Date
Other Official Date
County of Albemarle Department of Community Development
401. Mcfntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 k'ax: (434) 972-4126
Revised 7/1/2411 Page 2 of 3
OB/01/2015 09:43AM 4348231593 CHILES PEACH ORCHARD PAGE 02/03
Intake to complete the following:
Y �[N j
Is w n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Deport (CER) packet.
Y/N�Wil be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we rwelve approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or public water?
If private well, provide Health Departnlxent farm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
Y
Wi ou ,( o
be putting up a new sign of any kind? If so, obtain proper
Sign Permit
Permit #
Wille be any new construction or renovations?
If so, obtain the proper Permit.
Permit #k
Zoning to coml)lete the following:
Reviewer to complete the following:
Square footage of Use:
Y / N
Permitted as:
Under Section -
Supplementary regulations section;
Parking fbrttmula: 1A -- L a
afk&
Required spaces:
Y1N
Items to be verified in the field:
Inspector :.
Notes;
Date:
Viola '
If s#:
PrafC
YI
If so,
Va 'ZnN-:
YIN
If so, 'st:
Y N
If ist:
Clearances: olag_ 5
SDP's
Revised 7/1/2011 Page 3 of 3
Pancake 5k Fundraiser Chiles Family Orchards
CHILES FAMILY ORCHARDS
TODAY until gam ViemJiQum
C A L E N ; �'j,
M r "a
Pancake Fundraiser
September 12, 2015 | C-ifles Peach Orchard
C-a-z-egery: Family Fury. Funaraise. a -ver'; Tags: family fun, pancake breakf acts, Westerr; Albemarl-
Resrue Squad
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Pagel of 5
http://chilesfamilyorchards.com/events/pancake-5k-fundraiser/ 8/27/2015
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