HomeMy WebLinkAboutCLE201600016 Application 2016-01-28L-�5 `- J L(21 U:5- co - v lc
Application for Zoning Clearance
CLE # (Q- J� ___ Lee
OFFICE USE O Y
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # J Staff: i
PARCEL INFORMATION
Tag Map and Parcel: — M Existing Zoning U
Parcel Owner: �Lat tr-%J4 301_gQg-ga[y.
.
Kau
Parcel Address: S12OWeAll I 30C ki City ffeSUiJ �-- State Zip 229�
(includg suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: IS— City y State zip7laDN
Office Phone:) 4Zy-ZDoa Cell # Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:�0-WLL�Ir-4-1-7%1
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
vehicles, and any additional information that you can provide:
I i ms 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 h ve' the er's " Sion to use the space indicated on this application. I also certify that the information provided
is true and accur to the be o m owled have read the conditions of approvaL and i understand them_ and that I will abide by them.
Signature G�nrpd David Lynch
APPROVAL INFORMATION Risk Management erector
Approved as proposed [ ] Approved with ,..,uu,...,u [ ] 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.
Building Official
Zoning Official
Other Official
Date
Date W
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
YI
Is us m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Yl�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 or .
If private well, provide Hed&LDopwlgent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or ltic sewe .
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
6/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 1
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: -2— '2-
n1
omitted as:
Under Section:'?=�
Supplementary regulations section:
Parking formula: y.7s lJ
Required spaces:
YIN -0
Items to be verified in the field:
Inspector • Date:
Notes:
Viol ns:
Y/ I
If so, ist:
Prors:
Y/
If so, List:
Variance:
6/N
If so, List:
s:
( /N
If so, List:
Clearances:
SDP's
ZD Z rz'S
Revised 11/1/2015 Page 3 of 3
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