HomeMy WebLinkAboutCLE201600048 Application 2016-03-09Application for Zoning Clearance
CLE #>'
OFFICEWW?-'R
PLEASE REVIEW ALL 3 SHEETS Check # Date:Receipt #Staff:
PARCEL INFORMAA�
Tax Map and Paarcel-
Parcel Owner: (dll; '-Q,, `' VW
Parcel Ad "s• =99ML W city
` 1 d rte or floor)
Existing Zoning
State Zip
Who should we call/write concerning this project? , A-1
Address :_171.7 "/13 IU"fio Sr City �� XASU10-A! State VA Zipz� It, 3
Office Phone: ,34+ 7,1-3 - 31 y Cell # 9%-773-2 Fax # &mail Ca f--Av Tdiu.4f Lo
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
r
Business Namefl�ype:
Previous Business on this site
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:
*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 owner's 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.
Signatureit- Printed/LA`{
APPROVAL INFORMAMN
Approved as proposed [ ] Approved with conditions [ ] Denied
7 Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 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 Date
Zoning Official-3acyl
Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y l
Is us m LI, HI or PD1P caning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will eoff
re 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 , �1
Is parcel on private well ublic water9
If private well, provide Heal eparfinent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic o ublic s '�
VYIN
ill you be putting up a new sign of any kind? if so, obtain proper
Sign permit.
Permit #
;N
N
111 there be any new construction or renovations?
If so, ob
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section: -2—
Supplementary regulations section:
Parking formula: 6 n r -2- n
J
Req spaces:
YI
Ite46 be verified in the field:
Inspector.-- Date:
Notes:
Viola ons:
Y/�
If so,� t:
Proffe :
Y/
If so,
Vari ce:
YIfN I
If so', -St:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
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