HomeMy WebLinkAboutCLE201600061 Application 2016-03-17Application for Zoning Clearance
CLE # `� A'
CLQ w a/G— d
OFFICE USF- O Y
PLEASE REVIEW ALL 3 SHEETS Check # 61� N Date:
Receipt # D 36al Staff:
PARCEL INFORMATION ff
Tax Map and Parcel: 'UO -CSO '" Existing Zoning_
Parcel Owner: A i qzf-"oiz �v tfw2-a 1.,�
Parcel Address: 91AOIPIvry "0014 172 -Ail.- City ekXW17irFV1"tate 11A Zip ON t I
(include suite or floor)
PRIMARY CONTACT �f
Who should we call/write concerning this project? eGlN-T 67(-zA V19;r-
Address : '/ � 1 NO r City 6 W Syl State Zip I
Office Phone: Cell # ` yl'/�'/'3� 'ax# E-mail C I-10 r f?rA_4 141 &r
wj�LLy/(4. Gan'l
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use IC Change of name 1C New business
Business Name/Type: V02" M e o yNC • P FJA 1-1 b LLY M 17 J4voe,,-:- G teAw I t<7
Previous Business on this site -'51hPr 7 6 4:54A, -r)q seayi to
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: OfW a LOCA viz j_ F61L 14 005C 540�i2t Nle
vl 1!' A L'i NG G><S VEriiG v &'r-
00 2 woi+z-!c /!V O
*'Phis 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 di est of y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed i::�' L I KT 6r—,A V I S
APPROVAL 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 --I It
Zoning Official�L✓ Date .-3117Z
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
Intake to complete the following: 10 i1�
Yy N
Ts use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /l'tfi
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 o ublic ?
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 ap
Is parcel on septic public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain
Sign permit. Atk::"Y
Permit #
YnN
WiltMere 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: I I o 6
I&/N
Permitted as: -i �,�@- r ��. c�✓
Under Section: 'Z2 ,2 _1
Supplementary regulations section;
Parking formula:
G�] 7
Required spaces.
Y/p
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y/N
If so, ist:
Proff s:
Y/f
If so, List:
Variance:
Y/A
If so, ist:
SP's:
�/N
If so, List: 6
Clearances:
SDP's
Revised 1 ill/2015 Page 3 of 3
MOLLY MAID
3500 Seminole Trail
Charlottesville, VA 22911
• 1
o[
of4tc t1kyorr., 01 wlws10KS
VIM
oppy. t I 100 �w F�
Molly Maid of Albemarle