HomeMy WebLinkAboutCLE201600004 Application 2016-01-11Application for Zoning Clearance
CLE # Je/6'
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check# ^7567 Date: /-7-1 CP
Receipt # /6,Q774, Staff: 466
PARCEL INFORMATION r�
l
Tax Map and Parcel: to / I/'' Z$ -�-- I VA Existing Zoning /t+ _
bEmt4 ldcc
Parcel Owner:—,d/ L� 6 ,---X/?,y0!9
Parcel Address:_ ,,&3 6 SCA -m-12 6•� City C. ML-kL)4 State of Zip
(include suite or floor)
PRIMARY CONTACT r -
Who �� el rl Jt' /i A -n
should we call/write concerning this project?
Address: Z 0.3 S &,74 $ 1. Sr4i j 6-0 City e" V '7 /-- State zip 2 2 q 0!
Office Phone: `t; Cell # 7'7^ W 2Fax # E-mailL-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ✓ New business
Business Name/Type:
Previous Business on this site Vey'rtd Alf ' _ ,vid. !( AdrrLj,�
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:
*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 best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed a'9 J i+ �f• ot s'+
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
j 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 r DateUk
/ 6
Zoning Official SUV Date 5, .24jL
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
.G'L..),
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /� N�
Will 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 one that applies
Is parcel on private well orr?
If private well, provide Health Department form.
Zoning review can not begin untiI we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic o ublic
Y
Wil u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y0Wi re 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: _ -7 Q S r , Tom•
Permitted as: dr I
Under Section: -81,14,
Supplementary regulations section:
Parking formula. 41' ��
Required spaces:
Yl
Items o be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3