HomeMy WebLinkAboutCLE201600091 Application 2016-04-26Application for Zoning Clearance
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CLE # Q
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OFFICE E O Y
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff
PARCEL INFORMATION
Tax Map and Parcel: _ .�- y�G 03_204--0�,V-ey;ll 60 Existing Zonin
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Parcel Owner: )-ennef_ AMV 1j�iq AF r�
Parcel Address: t� 1� r? �^ �/ cityA Qi� S v, /� State V �
Zip
(include sui a or floor)
PRIMARY CONTACT /
Who should we call/write concerning this project? ,) `-Iw// j9l1(,syV
Address : J �/,�/ le� % �5� J�-2 City r c//50 k� State Lw
I, Zip-��� f
Office Phone: 7{ Y) e" ,�(/Cell # a 2-2/ 'Fax # I -� 1-2�13 -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use % —Change of name New business
Business Name/Type: �",p �/+ �L C '1 �//,, � Sql1 �44,4e) 47/ / 7v�s ��,s a
Previous Business on this site_. Ark aVIr ne,
Describe the proposed business including use, number of employees, er f shift availa le ar ping space, number of
vehq11e an any additional informatio th t you ca provide:P.s lw- & J'
*This Clearance will only be valid 6n tb6 parcel for wh ch if is appr ved. If you chang , inte sify or m e 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 st o y dge. I have read tht=ditions of approval, and I u derstand them, and that I will abide by them.
Signature y,��
Printed %�
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•
�~ S
Official Building ODate
Zoning Official Date Z `�
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 1 1 /02/2015 Page 2 of 3
Intake to complete the following:
Y /(q
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Will e 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�r?
If private well, provide Heant 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 ubllc se
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
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.
O/N
Permitted as:
Under Section: '1-" •� •�
Supplementary regulations section:
Parking formula: 9
Required spaces:
_ icy
YIN
Items to be verified in the field:
Inspector • Date:
Notes:
Viol ions:
Y/
If so, ist:
Proffers:
Y/1b
If so, List:
Varia
Y /
If so, Est:
SP's.
Y I
If so -, ,List:
Clearances:
SDP's
4-
Revised 11 /1 /2015 Page 3 of 3