HomeMy WebLinkAboutCLE201600058 Application 2016-03-24Application fo o ing Clearance
CLE P
OFFICEN
PLEASE REVIEW ALL 3 SHEETS Check # WoA Date: '
Receipt # 1 Staff:
PARCEL INFORMATION
Tax Map and Parcel; Existing Zoning p p�L
Parcel Owner: L
5"76 -Rob
Parcel Address:_ I-5 i8wx -V. City state VA __ Ziagz7oz-
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? %JAIL _1� - -
Address: 5 6W 9&AP _5a ; sy-rix g City 10Aw& UIw _ State., 699f:%/A Z0021?'
?'
Office Phone: E fin) & rZ -0.1oo Cell 4 may- AM `Jfo'Fax #77b-(RZ -110A E-mail l7AN iPS7Gp11'1' SrW7-,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
.Business Name/Type: 494-! /`�O�ou
Previous Business on this site UA-'bW- W.A-9P60 S(T-
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: a e go,?- W. Pr- Ai3G_LiQuan? CAtAkPtANLLL)
*This Clearance will only be valid on the parcel for which it is approved, If you change, intensify or move the use to anew location, anew Zoning
Clearance will be required.
1 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 accu
rate to e best of my knowledge.
T have read the conditions of approval, and I understand therm, and that I will abide by them.
Signature Printed
APPROVAL IMFORMATION
.DKI Approved as proposed [ ] Approved with conditions [ I Denied
[ ] Backflow prevention device and/or current test data needed far this site. Contact ACSA, 977-4511, x117.
( j No physical site inspection has been done for this clearance. Therefoto, 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 Date Z; /2t,
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice. (434)296-5832 Fax: (434) 972-4.126
Revised t 1/112015 Page 2 of 3
Intake to complete the following:
Y / C7Y
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will 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 ptrbtlt w ?
If private well, provide 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 4u is 9
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
IN
ill there be any new construction or renovations?
If so, obtain the proper Permit,
Permit# 1 -OM—, 339 AC.
Zoning to complete the following:
Reviewer to complete the following:
17,
Square footage of U61se: � C?
IN i
ermitted as: I
Under Section:
Supplementary regulations section:
Parking formula: 9 -1I -
A— 490
Required spaces: 15
YI
Item o be verified in the field:
Inspector • Date:
Notes:
Violations:
Y/
If so, ist:
roffers:
N
so, List: -
ag�./
Vari ee:
YIW
If so, hist:
SP's}},�
Y/U
If so, List:
Clearances:
SDP's
Revised 11/1/2415 Page 3 of 3