HomeMy WebLinkAboutCLE201600011 Application 2016-02-04Application for Zoning Clearance
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CLE # 2 b I L9 - 1 I
PLEASE REVIEW ALL 3 SHEETS
OFFICEUSE ONLY
Check # _ 40`7 Date: i a5l) U
`7 b%S
Receipt 105010 Staff:
PARCEL INFORMATION Plantud WXJ Comm.
Tax Map and Parcel: }? dLV C G L `'] 5 A _ „ _._ Existing Zoning
u �1 l
Parcel Owner: CORD :bDusW. "TlO�GuVtdS lylG
Parcel Address: 2040h6m Rd •5411 " 1 o; Lity C41dd6fft.S fl1L. Statey A Zip 921r
(includes aorohoor)
PRIMARY CONTACT
Who should we call/write concerning this a O Vcv
project? _ir�,yti
Address PO bort 34y42- -fix 2_ _ City �:edjrt State WA- Zip 961
Office Phone: l a_W -316 lo -5 I Cell # Fax # ZOLa 403 U -mail gu 6vt v e-sw buds.
APPLICANT INFORMATION
Check any that apply: __X Change of ownership C Change of use Change of name New business
Business Name/Type: cl ff" *We_—Hy 1 QU Y1Q5 ( ent_ S t Z = L CKS
Previous Business on this sites akjzuckS Ot YAnrL4or`. "a, &Sfaju„fks %Wt I A 2A
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:
2 0 &I ers
*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 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 accat to a best o y kn e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatur Printed (, [ (� 1►i L� ILtyk ev- _
APP AL INFkkMATION
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 I
Z
Zoning Official Date _ 2-Al2;o/l
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 295-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/6
Is use in LI, HI or PDIP zoning? If so, givr. applicant a Certified
Engineer's Report (CER) packet.
IN
ill 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 r publi er?
If private well, provide H artment 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 u ewe
Y/N
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
09/N -1
Permitted as: ) -j
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: / —
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations: o
ffers:
Y/A N
If so, ist: If so, List:
19 9�
Varig e: SP's:
Y/1 YIN
If so, ist: If so, List:
Clearances: SDP's
Revised 11/1/2015 Page 3 of 3