HomeMy WebLinkAboutCLE201600173 Application 2016-08-08Application for Zoning Clearance
CLE # 2b Vt - 113
0
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE NLY
Check # Date: �f 1
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
_
Parcel Owner: CIr1 e�� jam$
Parcel Address:U-5 05 Qrypl el r City � -� 1 � � State U A z1P4 W
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: spry-)-p— City State Zip
Office Phone: ( �1- 113�QCell 3�"LQ�D Fax # E-mail
APPLICANT INFORMATION
Checit any that apply: Change of ownership Change of use Change of name New business
Busin. ss Name/Type: k Q� `- -�(� SQjk0'6_//
Previo•is Business on this site _ „Q X
Descry a the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicle: , and any additional information that you can provide:
*This Cie -ance 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 ce.='.ify 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 r,curate to ttW beg of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed SlvirS
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 _ R at ( ce,
Zoning Official Date 4'4z
Other Official U, Date
County or Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
713 - ! u-� Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there 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 publie ?
If private well, provide H artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or pnrb�er?
Y/N
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: Uy 6.
/ N
Permitted as:
Under Section: _ / AA,yf+�;� ;Ge--_
Supplementary regulations section:
Parking formula:
Required spaces:
Y I
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ns:
Y/
If so, ist:
Pro rs:
YI
If so, List:
Vari ce:
Y/V
If so, List:
SP's:
Y/A
If so, ist.
Clearances:
SDP's
J ~
Revised 11/1/2015 Page 3 of 3
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