HomeMy WebLinkAboutCLE201600013 Application 2016-02-29At
Application for Zoning Clearances fi
CLE#kl(g- /3 _ �� "'
OFFICE _ LY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # inn Staff: ZIA
PARCEL INFORMATION
Tax Map and Parcel: ^ C>S —00 O Existing Zonin aL
Parcel Owner: M1 Wt►ol Y le 9 ko1�-'e-• 14Ar � L L4— - --
u,�*'3ta 1
6� Cit L State Zip
Parcel Address: - �C lA�►1P_ _.�.— Y
(include suite orfloor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: 15OL6 rje3.V 1a CityD $ e. State VON- l 1 Zip2sa ►at
Office Phone: (_I Cell # 703 46R is ' ax # E-mail ixIj i . D, 0th
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business NamelType:_� W V 11/0►�tAtrw d ha��u^' w�k�•�"�-�
Previous Business on this site !1t I i
Describe the proposed business including use, number of employees, number of shifts, available parking spa es, number of
vehicles, and any additional information that you can provide: �n _kAA*J&VC f 2- s( ck-Zo
zip. d !i a %^-e .r
*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 owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurate est of my knowle ve read the conditions of approval, and I understand them, and that I will abide by them.
Signature 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, 977--4511, x117.
[ J No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ I This site complies with the site plan as of this date.
Notes;
Building Official Date
Zoning Official Date7.
's l
Other Official Date
County of Albemarle Department of Community Development
401 Mclutire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
ot%( .
171
Intake to complete the following:
Is1
Is usm Ll, H] or PDIP zoning? if so, give applicant a Certified
Engineer's Report (CER) packet. 1,1M D
Y
Will 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
Reviewer to complete the following:
Square footage of Use: i3
01 N ►�
Permitted as: :�'12*141
6�nder Section:
Supplementary regulations section:
Circle the one that applies A
Is parcel on private well or blic 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 apnpubliers
Is parcel on septic ewer?
YIN
Will you be putting up a new sign of any kind?
% Sign permit.
Permit #
Parking formuia: I /
Required spaces:
YI
items to be verified in the field:
If so, obtain proper
Inspector: Date:
Notes:
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #1
Zoning to complete the followin
Violations: P offers:
YI� 61N
If so; List: If so, List: t C3�3
/I
Variance: SP's.
(IN Y1
If so, List: If so, ist:
Clearances: SDP's -7
-
Revised 7/1/2011 Page 3 of 3