HomeMy WebLinkAboutCLE201600056 Application 2016-03-18Application for Zoning Clearance A'
CLE# ,'9616`000n: Tp �r Nor
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # -5"/ Q 7 Date: 3 -16 -mol la
Receipt # /e 3 4, Staff:
PARCEL INFORMATION a2 a4.01
Tax Map and Parcel: ��I �`? �G�J%7�7[�/t'll ry t d&!2� Existing Zoning
Parcel Owner:.
Parcel Address: a�??7ITJ) iC ty C� Isf'ls�te +V zip0-70k-96V
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address; `_6'9 LXAIF,�W jQ��- City C:>f1�IN� %'g State [J',(P► Zip1_931111
Office Phone: 61(J q&1 # SMn't- Fax #/ E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: j0,,1
Business eha e --S
Previous Business on this site &V_A0W__d21
Describe the proposed business including use, number of employed, number of shifts available parking spaces, number of
vehicles, and any additional information thatayou can provide: V)Vle �4.1wr/qeeS ,
*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.
Signature�F�P� C�I'.�G '"dam— Printed f�`���'�°�''�e�4t
APPROVAL INFORMATION
Approved as proposed f ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for 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 / Date (! Y f 6
Zoning Official 6 Date 0A
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 11/1/2015 Page 2 of
Intake to complete the following:
Y
Is use in LI, Hl or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. C1 1 ' C&wt
Y
Wi 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 u tc water9
If private well, provide Healt epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies-----
Is parcel on septic or blit sewer?
Y,l N
dill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit# �3_fed 1
Y
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZOBiB9 to com Tete the following:
Reviewer to complete the following:
Square footage of Use:
� / N
Permitted as:� 1 f
Under Section: "L� •2 •r
Supplementary regulations section:
Parking formula: ,1
Required spaces: 17
YI
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/{1T�
If so, ist:
Proffers:
Y/n
If so, est:
Variance:
O/N
If so, List:
SP's'
Y/
If so, 1st:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
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