HomeMy WebLinkAboutCLE201600213 Application 2016-09-22Application for Zoning Clearance
CLE # ,eX>K.Q 4
OFFICE U ONLY `rA fB
PLEASE REVIEW ALL 3 SHEETS Check # Date: ! "1 W
Receipt # Staff:
PARCEL INFORMATION �{ 13
Tax Map and Parcel: "y ! a Existing Zoning Ci eri S
Parcel Owner: x e C n�sacjah.(_)DF IVIC,
Parcel Address: City State Zip
(include suite or floor)
PRIMARY CONTACT / r {� ��
Who should we call/write concerning this project. / X !ke
Address: �, [ TljAtk City Statey Zip Ufa
Office Phone: ) ,2 f.3 =15-0( Cell #4W _ Fax # Z-13 - E-mail �br� rfe tdi` ��o� ellCr
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: cooIrpore! ,c ,
Previous Business on this site ���
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: cr—es. „-
*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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �tll Printed .. 6 6 L&4f e_c--F.,e,[
APPROVAL INFORMATION
J Approved as proposed [ ] Approved with conditions [ ] Denied
[ j Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x] I7.
[ ] 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 C' 4--a
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 11 /l/2015 Page 2 of 3
,J..
Intake to complete the following:
Reviewer to complete the following:
Y / N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Square footage of Use:
Engineer's Report (CER) packet.
(P/ermitted
N
/ N r�
as:
Will there be food preparation?
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE 5r /9p -, 6
Circle the one th=wel%l
Parking formula:
Is parcel o rivr public water?
If private well,alth Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
YIN
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y /0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector. Date:
Y /
Notes:
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y/(N
Proff rs:
Y/ V
If so, ist:
If so, List:
Variance: ance:
Y / V
If so, List:
S 's:
:Y) N
If so, List:
Clearances:
SDP's
Revised 1I/1/2015 Page 3 bf 3