HomeMy WebLinkAboutCLE201600060 Application 2016-04-09Application f r Zo 'ng Clearance
CLE M
OFFICE U
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel:. _ O 7CM I w 0 0t-60 — 02 7 00 Existing Zoning _pr1(,
ParcelOwner: so 5awsr 6r
Avc-
Se.M.qoe,
Parcel Address:_ _M GHA�erT tn%&K _ City 1 H �r1.F_State VA zi L
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? DAIJ TAG{( --- __
Address: s 5Wl CiP. O. S TZ-W _5 tM City r-Af,29 tieN State 6&Q962/A Zip 3021
Office Phone:C7!O) poCell#*A1-2Yr_V?JFax#77o-0?Z-$3nZE-mail DAM iPS269U'1'JSr__g.,T./t:v'1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: QQOEM
Previous Business on this site /&IO5f
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: I o I R_ �{
*This Clearance will only be valid an the parcel fbr which it is approved. If you change, intensify or tnove the use to a new location, anew Zoning
Clearance will be required.
Ihereby certify that I own or have the.ownees permission to use the space indicated on this application. I also certify that the information provided
is true and accurate �Exe best of my knowledge. I have read the conditions of approval, and I understand them, and that 1 will abide by them,
Signature Printed I._Gr Ll2id'f C, 1 t J 14'tJJ
APPROVAL KWORMATION
Approved as proposed ( ] Approved with conditions [ ]:Denied
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl I7..
[ ] 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 Bate L{ 1(
1
Zoning Official Date--
��r
Other Of1"tcial Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-M2 Fax: (434) 972-4126
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y /(D
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will Were 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 er?
If private well, provide HeakbJDqmftment 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 he sewe .
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
Will there 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: ;L) '2—
O I N
Permitted as: &j Lqyllt, 1'
Under Section: -Z--5 2
Supplementary regulations section:
Parking formula:
GcaJ
Required spaces:
YIN
Items to be verified in the field:
Inspector • Date:
Notes:
Viol ons:
Y/
If so, -List,
Proffers:
()/N
If so, List:
Varia ce:
Y /F
If so, List:
Y KN
If so, test:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3