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HomeMy WebLinkAboutCLE201500166 Application 2016-01-07Application for Zoning Clearance CLE # dD OFFICEUSE NLy PLEASE REVIEW ALL 3 SHEETS Check # U Date: Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: -��txof� Parcel Owner: 11'�0 LooGe lAc, Existing Zoning_T A- 51 q ' At a40T_A� Lel Parcel Address: I l l City 0&uaj�&4,tE State (include suite or floor) 0 Zip PRIMARY CONTACT Who should we call/write concerning this project9 Mlycw"'J'-4 Address : � • �ox City L 1kV1 LLL State ■ Zip Office Phone: � q ti Cell # Fax # E-mail UA&4%j it-$ &UUV�Dp.i' APPLICANT INFORMATION Check any that apply: /I Change of ownership Change of use Change of name New business Business Name/Type: e i1 1;�.L_ �i?U Previous Business on this site N I & Describe the proposed business including use, number of employees, nurr er of sfts, a able parkin spaces, n tuber of vehicles, and any additional information that you can provide: �rv[ S u1C ;'N�riO IC I NC, - q *A *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 o e th owner's permipwh to use the space indicated on this application. I also certify that the information provided is true and accurate to e b of knowled ave read the conditions of appy al, and I9,Aact— APPROVAL derstanndthem, and that I will abide by them. Signature Printed Aw 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 W6 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: Y1 Is u LI, HI or PDIP 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 public water? If private well, provide 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 septic or public sewer? YI Wil u be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / Wil et'[fi re be any new construction or renovations? If so, obtain the proper Permit. Permit # ZoninLr to comulete the following: Reviewer to complete the following: Square footage of Use: ip f Il 1 r7v - .l Supplementary regulations section: Parking formula: Required spaces: 64 YIN Items to be verified in the field: Vios: Y If so, t: Pro Y N If st: Var Y kNY if ist: SP's Y fNj If A&<ist: Clearances: SDP's Revised 7/1/2011 Page 3 of 3