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HomeMy WebLinkAboutCLE201600025 Application 2016-02-12Application for Zoning Clearance #, `l/ 0CLE OFFICE USE O Y PLEASE REVIEW ALL 3 SHEETS Check # Date; - y ! Receipt #. /D3 5- Staff: PARCEL INFORMATION C Tax Map and Parcel: / jC 1�11q,4 7 0 �/ 62- .7 Existing Zoning Parcel Owner: /f c tar e: Gond >c 1S1Lc�>' Cu uS acs. �! Parcel Address: y City , r, Stage i Zip -Z2 -Fe (i elude suite or floor) PRIMARY CONTACT 0i Who should we caWwrite concerning this project? Address: MR R&"_nn,( 449— City 01.• a � �1 t- State Zip�72 Office Phone: Cell# 5W,- �KFY Fax # _ -S E-mail $ 7�cw�il.`li,�;a[�.+dc'�r�aaF... APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: Q � &y a ,e 41 Previous Business on this site 771-4" � L' .& 2, e Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any adliti nal information that ou can rovide: G'�77� G C ��,, % - a c� /Gc is ter^ s' .,!7�ax✓�J+ r�v� - /!s� -- - *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 t I o or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and actor t t e bes f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. 0-1- 4,/)� Signature PrintedEy(Jl, 'PROVAL INFORMATION 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 _�J t( 1 t Zoning Official Date / Z-LZ�b/� 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 11/02/2015 Page 2 of 3 W*^ Intake to complete the following: Y/® Reviewer to complete the following: Square footage of Use: qct o 11, F Is use in Li, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. / N , r(� 0'rinitted YI© as: CA SC% Will there 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 SP's• Yl If so, est: Circle the one that applies Parking formula: Is parcel on private well o ublic water?� If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE SDP's YIV Circle the one that applies Items to be verified in the field: Is parcel on septic o ublic sewer? YIN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector: Date: Y / ) Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to comDlete the following: Y / Violations:Pr3ist: If so, t: s: Y If Varig e: Yl If so, ist: SP's• Yl If so, est: Clearances: SDP's Revised IM /2015 Page 3 of 3 8 EXHIBIT A FLOOR PLAN 198 SPOTNAP ROAD, SUITE A-4 CHARLOTTESVILLE, VIRGINIA 390 SF F L 6'-S" WINDOW C. zr.cttiasvJll'3, VA dP, -? F% 011