HomeMy WebLinkAboutCLE201600146 Application 2016-06-29 (2)Application for Zoning Clearance "`_
CLE # :jc � / y . . �„
OFFICE USE ON�TLY
PLEASE REVIEW ALL 3 SHEETS Check# ` 4Q Date: 6-,V3-✓0
Receipt # Q q 4P Staff: d
PARCEL INFORMATION
Tax Map and Parcel: _ ��Jd b " L�(p®C� Existing Zoning
Parcel Owner:
Parcel Address:__ 104 two , ? f&, �yl Ul301 Cityau)AkN;A_&State Zip li�j 11
(inclu a suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Jer
Address :_ 6 2 a CNIA 0dj City State &I Zip o
Office Phone: Iffift Cell # Fax # -mail 1 +tue he,
APPLICANT INFORMATION
Check any that apply: �7 ill' Change of ownership Change of use Change of name New business
Business Name/Type: 1�f34�,dba
Previous Business on this site P
Describe the proposed business including use, number of employees, number ofshifts, available parking spaces, number of
vehicles, and any additional information that you can provide: ���(2.InA441
"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 to qbest of my ow a ge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed___
APtRdVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ ] 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 e Dater I
Zoning Official Date
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 ]/1/2015 Page 2 of 3
Intake to complete the following:
Y
Is u m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wil 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 that applies
Is parcel on private well r public water?
If private well, provide H mTrF0ffTbrm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
.,
Is parcel on septic o ublic sewe
Y
Wia be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper I
Yl
Wil ere 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: c
Y N 'A
rrnitted as:
Under Section:
Supplementary regulations section:
Parking formula: bm IQ
Required spaces: (IS)
/N
It _ e verified in the field:
Inspector -
Notes:
Date:
Violations:
YIN
If so, List:
A3foffers:
YIN
f so, List:
Variance:
YIN
If so, List:
SP's:
YIN
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
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