HomeMy WebLinkAboutCLE201600141 Application 2016-07-01Application for Zoning Clearance'"
CLE # oZDI1,A - 1-11
V
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # f t D w Date: Co 13 I tv
Receipt # l 0A.'W5 Staff.
PARCEL INFORMATION �1
Tax Map and Parcel: o,nn�pe) -on - ®OT C�s-S' {'t-o Existing Zoning m �1 M �-
Parcel Owner: _aOlK uz_
Parcel Address: ILi 119 'rs C_' C. A-302 City41,lGir7laxyl'/e State f � Zip.��//
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?.�A�
Address : 9g Ri.+'"I ,)'Fty e CityO44r'l T/xf-4- State t 4� Zip
Office Phone: `� Cell # 9tYc?SW� Fax #Zr- E-mail ?g .¢dco+ may• [
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: CIPWST
j
Previous Business on this sitc_,4!&o _cems4ru c_`[ i e n
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
���,
vehicIes�and any additional information that you can provide: rYlCa�)'��GL= Cam. Co' 7 �w,P t1&__S:
6,-7,<"`�L�s.
*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.
1 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 the est ofm�ry, knowledge. I have read, the conditions of approval, and II understand them, that I will abide by them.
,a�n/d�
Signa e I y / V ` �JC- �►1 Printed •'tom I+�y� /r t F, �d n
ROVAL 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 Date
Zoning Official _9__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 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet,
Y l
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 that applies
Is parcel on private well or ublic water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE _
Circle the one that applies
egIs parcel on septic or �licsa r
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 # B 1201(Q - Li Yla A C
Zoning to complete the followine:
Reviewer to complete the following:
footage of Use: 43 0 a I
Litted as: r ^
Under Section: �!� l� • ` f ��
Supplementary regulations section:
Parking formula: 'law
^
Required spaces: `
Y /
Ite a verified in the field:
Violns:
If 1
If soEst:
P'Q ffers:
N
Vso,List:
VariZn�ce:
YI(N�
Ifs List:
's:
JYIN
o, List:
Clearances:
SDP's
Revised 11/1/2615 Page 3 of
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