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HomeMy WebLinkAboutCLE201600085 Application 2016-04-09Application for Zoning Clearance �_ CLE # `62... & �,�F r OFFICE PLEASE REVIEW ALL 3 SHEETS Check# a ©ate.: (p Receipt # Staff. PARCEL INFORMATION Tax Map and Parcel: Existing Zoning_ ,0 Parcel Owner: f6pvcwG S&M- 4oe Parcel Address: v &X -W. City G���(AF-Stste VR ZiAgglOZ (include suite or floor) PRIMARY CONTACT Who should we calllwrite concerning this project? 1-?A1J Address: Jr 5W _ i(D Sfj7 � �r1 City ft- .Upi Stute �O' IA zip3oZ13 Office Phone- C??rO}44Z-$3c9o_Cell #Vvj� 2''=`�lefFax #2%-QFZ-If34E-,mail D�4N�S�CoGlt..t5�1.(�I APPLICANT INFORMATION Check any that apply: Change of ownership Change of use. Change of name New business ( A�% - :Dcjk 7) r " Business Name (Iype: U& ALo Previous Business on this site /y�y UA 1I"M2 SrTF- 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: 1, `%Z SG�. rr. G = NI}i -S (M�te3f'I�) "This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use tog new location, anew 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 approvat, and 1 undersumd them; and that I will abide by them, Signature 6 Printed r rloT APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflo.w prevention device and/or current test data needed for this site.. Contact ACSA, 977-4511, xl 17.. [ ] No physical site inspection has been dome 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 r DateIL Zoning Official t�,✓ -- _ Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5532 Fax: (434) 972-4126 Revised 1 l / 112015 Page 2 of 3 Intake to complete the following: Y / Is use m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y 5 Will there 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 If private well, provide HeiE�ater? ment form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE Circle the one that applie Is parcel on septic or is sew ? 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 followine: Reviewer to complete the following: Square footage of Use: /% 6� V1 N Permitted as: id do i' Under Section: Supplementary regulations section: Parking formula:✓� vv� Required spaces: YI Items Ybe verified in the field: Inspector• Notes: Date: Violatjons: Y IV If so, List: rollers: /qI N so, List: 2JtJQ- Variance: 1' If so, st: Y SPNist: If Clearances: SDP's Revised 11/1/2015 Page 3 of 3