HomeMy WebLinkAboutCLE201500238 Application 2015-12-03o
Application for Zoning Clearance
CLE # bolb..
OFFICE USE
PLEA'w,E REVIEW ALL 3 SHEETS Check# � Date:
Receipt # Staff:
PARCEL INFORMATION �q
Tax Map and Pr. reel: 0 3,5 pC1 fl 6 6 6 G % � � /�_ L� J-. Existing Zoning
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Parcel Owner:_ Cess 4 f_6 ODA P i r
Parcel Address:. U Ci ! y�( State __ y _Zip
(include suite or floor)
PRIMARY C JNTACT
Who should we all/write concerning this project? h,r�d� ►'/fie
Address: /b 6 Quij 2u, city[ ,M LAU-t& State VA _ —Zip Z z4/1
Office Phone: L� 7A _C�- r-ji;o Cell # Fax #T*'11 (14C E-mail U 1AY V({1 V V' 1'L YU �6
APPLICANT INFORMATION
_Check any that apply: v/ Change of ownership JI Change of use
Business Namei 'ype:
Previous Busine:.s on this site U(' L•d.ZET
Describe the pre )used business including use, number of employees, numl •er of shifts,
vehicles, and an- additional information that you can rovide: '�4'' fx
�� 1�3��Gt�r.4rr�►c��r_ cM cA,fi�17�M rtk'
;e of name New business
available parking spae-es, number of
Ga _ -- ln-AkC1'+l3U-Ke ^ice 4+-U'►r —
*This Clearance wi'' only be valid on the parcel for which it is approved. If you change.; intensify or move the use to a new loci: don, a new Zoning
Clearance will be r 4uired.
I hereby certify tha I own or have the owner's permission to use the space indicated on . its application. I also certify that the ir,brmation provided
is true and accurate :o the best of my knowledge. I have tread the conditions of approval and Iunderstand them, and that I will a ide by them.
Signature �, l T%` Printed f_ao> _ f 1A Yl�
APPROVAL NFORMATION
[ ] Approved as iroposed [ ] Approved with conditions [ ] Denied
[ ] Backflow pre .1ention device and/or current test data needed for this site. C ;ntact ACSA, 977-4511, x117.
[ ] No physical . inspection has been done for this clearance. Therefore, it : s not a determination of compliance with the existing
site plan.
[ ] This site corr, plies with the site plan as of this date.
Notes:
Building Offici it Date I q f I
Zoning Officin Date
Other Official Date
County of Albemarle Department of Cc nmunity Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fag: (434) 972-41: 6
Revised 7'1/2011 Page 2 of 3
Intake to comp:,ete the following:
' N
Ase in LI, HI or P 71P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YIN
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 or lic w r?
If private well, provide Hea1&j2cpoA1hent form.
Zoning review can !rot begin until we receive approval from Health
Dept. FAX DATI_
Circle the one that applie
Is parcel on septic or c sewe .
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
Will there be any new construction or renovations?
I€ so, obtain the pro.,er Permit.
Permit #
Zoninur to cominSete the following:
Reviewer to complete the following:
Square fo( tage of Use: 56o3
Permitted as:
Under Se(.Idon:
Supplementary regulations section:
Parking formula:
Required spaces: !
Items to bc verified in the field:
Inspector
Notes:
Date:
ns:
Vi3ai`st:
Y
If
Proffers:
YI
If so, ist:
Varia ce:
yl Qe
If so, List:
SP's:
N
If so, List:
Clearances:
SDP's
Revised 711/2011 Page 3 of 3
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