HomeMy WebLinkAboutCLE201500242 Application 2015-11-30Application for Zoning Clearance
CLE # L`
i'
OFFICE W -
Tax
PLEASE REVIEW ALL 3 SHEETS Check #Date:
Receipt #Staff.
PARCEL INFORMATION Map and Parcel:_ jj j - Existing Zoning_ Hz!; 4.,� cem
Parcel Owner: -4 y=`� T CO c�
Parcel Address: IS 1473 SCCJ+�A"J,i 1City S cG* j lay[ 1V State %/A Zip'Z'(J-110
(include suite or floor)
PRIMARY CONTACT i /�
Who should we call/write concerning this project? k.sn Allen len [i�i4ew -
Address: S10 6 MP -C red City _ dfl-1 0 i I State —V A-- _Zip -ZW1
Office Phone: ( 30°lll # �� �`- q Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type;t 1 ae Z-- f
Previous Business on this site & i,S [ G ---
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, numbe of
vehicles, and any additional information that you can provide: —3 e,^j2 knsi .e e S t o L i3C-U J z s t'k r c VS
*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 best of my knowled e. I have read the conditions of approval, and I understand them, and that I will abide by them,
Signature fJ. --� Printed_ DILA 41 I Ai' Lftj
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 _ ICS
Zoning Official.44�� �d�Date�L3 ZJ �T
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 11/1/2015 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? It so, give applicant a Certified
Engineer's Report (CER) packet.
Y .{ N
Wil ere 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 onrrivrate
Is parcel o we public water?
If private wevide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle theplies
Is parcel n septi public sewer?
YIN
ill you be putting up a new sign Qf any kind9 If so, obtain proper
Sign permit. `}�'
Permit # 11 `{
Y N .fid
Will ere 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: �00 0
IgIN
Permitted as: f'"C71 R s
Under Section: r
Supplementary regulations section:
Parking formula: t r� i
Required spaces: ,may
Y / //
Item o be verified in the field:
Inspector : Date;
Notes:
Vio 'ons:
Y
If ist:
Proffe :
If /
If so, ist:
Variance: OSP's:
/N
so, List: y_y
YI
If so, ist:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3