HomeMy WebLinkAboutCLE201600017 Application 2016-02-03Application fo Zoning Clearance
CLE #
OFFICE ONLY
PLEASE REVIEW ALL 3 SHEETS Check# Date: �- -
Receipt # Staff:
PARCEL INFO W.
Tax Map and Parcel: aw,Existing Zoning.
e
Parcel Owner:
Sa;nt;3�G
Parcel Address: 60Qyr s, "71 city Pjy Ei te- State UA
- zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address:SOV-5 ,).(; Ll City i�'L�SV "State ��� ,Zipc�d'10
Office Phone:
-� 1.4 Cell # 1S•' jdY- �? Fax # E-mail
CO/r)T
APPLICANT INFORMATION
Check any that apply:/_ Change of ownership Change of use Change of name New business
Business Nam e: X GVi = IVs pt,► T �a� -' @ `bis ��
Previous Business on this site PLvfd
Describe the proposed business including use, number of emploLges, number f shifts, available parking spaces, numb r of
vehicles, and any additional information that, ou n vide: a � jl., �; 4.
*This Clearance will only be valid on the parcel for which it is approved. If you change, in ensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that Ior have the owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurate. a l 't of m ow dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ` r PrimedV� r7� 16 VA
APPROVAL INFORMA ON
Approved as proposed [ j 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 -'J c f
Zoning Official Date
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/l/2015 Page 2 of 3
Intake to complete the following:
Reviewer to complete the following:
Y / Square footage of Use: r�
Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. (� / N
Permitted as: _ OPa C..
Y I `tlf _
Will ere be food preparation? Under Section: �.
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private we11 or er?
If private well, provide Heai D ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app i
Is parcel on septic or ic'sewe
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Parking formula:
Required spaces:
YI13)
Items to be verified in the field:
Inspector • Date:
Notes:
Zoning to complete the following:
Violat, ns:
Y/i
If so, ist:
ffers:
/YIN
so, List:
ZJ9 — /S
cc;
Y/
VarZist:
If so
SP'�s�.
Y/(N}
If s�.�i'ist:
Clearances:
SDP's
Revised 1l/IM15 Page 3 bf 3