HomeMy WebLinkAboutCLE201600171 Application 2016-08-08Application for Zoning Clearance
C:LE # o - 'I J is
OFFICE USE ONLY �� 1
PLEASE REVIEW ALL 3 SHEETS Check # 1551 Date:
Receipt # 1h5 12 Staff: 1'P
PARCEL INFORMATION
Tax Map and Parcel: _() (a i lam] „ EX2 Do — 1 �--S DO _ Existing Zoning
Parcel Owner: y� l q 1
Parcel Address: - ! � _ �i � l ;� Z W City 0I4 !t. ✓'f �t"'�AC ,S i i Zip��l /
(include suite or floor)
PRIMARY CONTACT {
Who should we call/write concerning this project? kf)
Address: q ZZI ` 1p _,� J U %
Office Phone: 43 4gg 3 - I''Cql
I APPLICANT INFORMATION
City d b Jop, I( p y � Zip
Fax # E-mail
I Check any that apply: Change of ownership Change of use Change of name l/New business I
Business Name/Type:
�7
Previous Business on this site
Describe the proposed business including use, number of employees umber of shifts available park' g spa es, number of
vehicles, and any additional information that you can provide: ��} �j,Q r7 r
*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 a to the best of m knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature V Printed ai--dlK'" 14 fZ k,6kAtaL
�PPROVAE INFORMATION '
] j Approvcd 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( t (o
Zoning Official Date? (�i2-9�
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
Intake to complete the following:
Is l
Is u LI, HI or PDTP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Yl
Will re be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin untiI we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o is:wa7te.If private well, provide H form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE.
Circle the one that ap "
Is parcel on septic r public sewe
V'YIN
ill 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: '0.GO
IN Y
ermitted as: ` I q t
Under Section: 2� �•
Supplementary regulations section:
Parking formula: /
%n -5 �y
Required spaces:
Y/
Items o be verified in the field. -
Inspector :,
Notes:
Date. _
Violations:
Y/(D
If so, List:
Proffers:
Y/
If so, st:
Vari ce:
Y/
If so, List:
SP's•
Yl
If so, ist:
Clearances:
SDP's
Revised i 1/1/2015 Page 3 bf 3