HomeMy WebLinkAboutCLE201600219 Application 2016-10-07Application for Zo.nin Clearance o
CLE #
OFFICE Uf Of LY ..
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 07900 - od). dQ - Q�j5 A2) Existing Zoning T C-
Parcel Owner: L�-o r L -
Parcel Address: & , c p� (-( - City " / State Zip•
(include suite or floor)
PRIMARY CONTACT 'f�
Who should we call/write concerning this project? ��. W A vs
Address:- P e.tita t)r(k VtF. Cityd_�[n sv,�/Sr State ji� Zip ��l
'�` -y� q�i q 9Y
Office Phone: l r� l4 !�I -�1 1 Cell # 10 6'2,Sr W Fax # 46` 5"/O E-mail . �!v oV+ ni ands a
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: ire re err ".1 ellv&e '5K1' " �.s )ee & q7�.
Previous Business on this site 41,1,d
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, tuber of
vehicles, and anyF additional information that y u can provide:
1- l�lfl,. {0 E t
*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 owners permission to use the space indicated on this application. I also certify that the information provided
is true and acc to the est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature t�LLPrintedVK,
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, xl 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 4{
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) 9724126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y /a
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y1
Will lere 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 o ubli - wat
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
Is parcel on septic o u 'c si ew�
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
(D/N
Will there be any new construction or renovations?
If so, abt=er
Permit#
Zoning to complete the followinin
Reviewer to complete the following:
Square footage of Use: i - &
f� I N
ennitted as: Gcv
Under Section: —25- A , Z
Supplementary regulations section:
Parking formula:
4)y b�
Required spaces: f
Y / �p
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/A
If so, ist:
Proffers:
®/N
If so, List:
Varian :
Y/
If so, -List:
SP's:
Y/6
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3