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HomeMy WebLinkAboutCLE201600044 Application 2016-03-07Application for Zoning Clearance CLE # nLo -_,�( OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # l0 76r Date; Receipt # Staff.- PARCEL taff:PARCEL INFORMATION Tax Map and Parcel: 77 + Parcel Owner: �1G1+v70p,5 t9 je©{ x Q L Existing Zonin Parcel Address. --/47C) IOATb-P �r �`/iA� �o Ui Ie- State (include suite or floor) 1, Zip �� }// PRIMARY CONTACT /� r Who should we call/write concerning this project?wac.� Address : T\ el� • L," 4 w -ea-}- City k., State _ VA- Zip 7,1000 Office Phone: (a'>J -47-- [1k& Cell # APPLICANT INFORMATION Check any that apply; Change of Business Name/Type: Fax # E-mail Uvtlatp. 4uwt0s `a,P va • e,011 of use Change of name New business Q. (. . Previous Business on this site & G UAt\-t Cp(%k� t� Q . S lex— L 01. CVt Wrft4:t Describe the proposed business including use, number of employeesn umber of shits, available parking spaces, number of vehicles, and any additional information that you can provide: *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. to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed / . )"U,,— APPROVAL INFORMATION '>d Approved as proposed [ ) Approved with conditions [ ]Denied [ ) Backflow prevention device and/or current test data needed i`or this site. Contact ACSA, 977-4511, xI 17. [ ] 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 Zoning Official A Other Official Date Dated 20. Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 11/1/2015 Page 2 of 3 ��cyii tt Intake to complete the following: Y /® Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wil 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 public ww er? 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 app1* Is parcel on septic or public sew ? V N Will you be putting up a new sign of an ? o, obtain proper � kind Sign permit. 7'V /3 Ofilotf Permit # Y Wi ere be any new construction or renovations? If so, obtain the proper Permit. Permit # to complete the followin Y / �N� If so; List Variance: Y /t) If so, List: Clearances: Reviewer to complete the following: Square footage of Use: i LA 3.y X �T b / N -, Permitted as: Under Section: Supplementary regulations section: Parking formula: Q %IM Required spaces: R YI Items'lo be verified in the field: Inspector : Date: Notes: SDP's Revised 11/1 /2015 Page 3 of 3