HomeMy WebLinkAboutCLE201500223 Application 2016-01-12�r
Application for Zoning Clearance `��'
a
CLE# 90 15— raa� ��,���.
OFFICE USE ON Y
PLEASE REVIEW ALL 3 SHEETS ehe k# S Date: i 1
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: SS 1E Existing Zoning
Parcel Owner• r _ 1'� Z L�
Parcel Address: l 1 � kon— 1�bb' State V� Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: City v u State V t
Office Phone: - Cell # r Fax # E-mail _
APPLICANT INFO TION
Check any that apply: Change of ownership Change of use hange of name New business
Business Name/Type:�#�U4-A[��� „
Previous Business on this site l �- _
Describe the proposed business including use, number of employees, number of shifts, available parking !BAC—es, number of
vehicles, and any additional information that you can provide: _� _ t✓tL—�
*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 accu to to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signat re ® Printed�—
APPROVAL INFORMATION
j 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 _ C (' t
Zoning Official Date III -Z-1111,6"
Other Official Date
w:ounry Of Eunemarie Department of Uommunity 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 use LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Q/ N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin un 'I we receive approval from Health
Dept. .9" DATE
Circle the 9e20'appYie-s)
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?
Y/N
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?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
rmitted as: � Q
Under Section:
Supplementary regulations section:
Parking formula:
�n
Required spaces:
YIN
Item be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/I
If so, List:
Pro e
ANJ
If so, ist:
Va riao ce:
Y /(Nj
If so, est:
's:
/ N
so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3