HomeMy WebLinkAboutCLE201600134 Application 2016-06-23Application for Zoning Clearance
CLE # . 07�� t0 - -
OFFICE USE Y
PLEASE REVIEW ALL 3 SHEETS Check # Date: Y 1te
Receipt # staff..
PARCEL INFORMATION
Tax Map and PaeYe1:J. 67'tV ` 00 M D 1,7 e— I Existing Zoning`
Parcel Owner: PSn, �Cs9 rk',� hvK
a �el "e ore v� It `v y ✓ a
Parcel Addre�:.3r State � „Zip
(include suite or floor)
PRIMARY CONTACT ,,J
Who should we call/write concerning this project? d /� t! ela C1 — 2eY-' rvy
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Address,.
I ' 3 �fCJZe .4ye City ze— State?� —ZIP
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Office Phone: ez City Il # Fax # E-mail
o67 a C.,,-azeet- 1 . Cow
APPLICANT INFORMATION 54
Check any that apply: Change of ownership
Change of u'se_A ---.Change of name _New business
Previous Business on this site —S t-4 r ` h 6e 4
Describe the proposed business including use, number of empb ees, n of sh' av ' spaces, number of
vehicles, aad additio informsn that cr
you can provide: 4 �C Paf n
*Phis 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 int'onnation provided
is true and accurate rto"do wledge. I have read the crud`' vat, end then►, I will abide by don -
Signature 0'0Prince d G 9
APP VU INFORMATION
[ Approved as proposed [ ] Approved with conditions ( ] Denied
( ] Backtlow 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 o this date. A
Notes:
Building Official Date
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5932 Fax: (434) 972-4126
Revised 7/1/2411 Page 2 of 3
Intake to complete the following:
Y/N
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) paJWL
Y I
N
Will be food preparation?
If so, give applicant a Health Department form
Zoning re'view can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin wail we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
Y/�T
Will ou be up a new sign of any kind? If so, obtain proper
Mi
Permit*t. aim
Y / [ rwL
Will re be any new nstrnction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
footage of Use:
/ N
omitted as: � 'r
Under Section: Y C
Supplementary regulations section:
Parkingformula:
Required spaces:Az
Y/ 14
lterrA4& verified in lice fwld:
Inspector : zDate:
Notes:
Vio
Y N
if
P
Yft:
yrls
V
if N_
If
SP's:
Y �:
if
Clearances:F —
Of I
SDP's
Revised 7/1/2011 Page 3 of 3
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