HomeMy WebLinkAboutCLE201600133 Application 2016-06-06Application for Zoning Clearance
CLE # �O/& 61
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # �P Date: J-31-0�bt 6
Receipt# O & j55 Staff:
PARCEL INFORMATION
Tax Map and Parcel: it�loi / QQ — 00 - 0 Q ! d g7AP _ Existing Zoning
Parcel Owner: F!v) is
EreelA;�, s: �.�� Box, o20 i - City 5: a /J State \% Zip .R-;.
�97 d7ludegD or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? [ M w, ,S�,w
Address: t05 cJfW206� Li-� C-I E City C GCAYL')t1"SV41� ate �it'i � 1Ai C'l Zip ZZq 4
Office Phone: Cell 1 9,b 3L09Fax # E-mail l3}AG e�� G� tvuC@ r L 60
MGS o } (� C �"}tirttc� Z• �
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: & Vf PK 0VAJCL� 6o UA�� 6kS7e--- &C,12, C, vo-f Ea.
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, nu ber of
vehicles, and any additional infor ation that you an provide: �. F',
VO d .
*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
jto� the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature 7`-CFPrinted-Q_ � iC7y 5 H 0 'P/��
T'
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:
Building Official Date
Zoning Official Date �a
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 3
h1.
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Intake to complete the following:
Y l
Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /: N
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 th lies
Is parcel on ivate 11 or public water?
If private well, ovide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel sep or public sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
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: 6 I5 D
Y/N
Permitted as: Car_An7�,/y-�►/�
Under Section: /0
Supplementary regulations section:
Parking formula:
Required spaces:
1eq
Item a verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/r4
y
If so,List:
Proffers:
Yl
If so, st:
ariance:
/N
If so, List:
Y
SP'Aist:
If
Clearances:
SDP's
Revised I l/l/2015 Page 3 of 3
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