HomeMy WebLinkAboutCLE201600155 Application 2016-10-12Application for Zoning Clearance
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CLE # Alta -166
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS heck # 1051'6 5 Date: 5 1 �
6
eceipt u i Staff:
PARCEL INFORMATION
Tax Map and Parcel: _ 1 , ,- �� — L ExistingZanin L [_
Parcel Owner:
Parcel Address: City. �-�4"�� i�.� State VA -Zip
(include suite or floor)
PRIMARY CONTACT }
Who should we call/write concerning this project."
Address : "i C. > City 7 State � r �i Zip 4&
Office Phone: f ) Cell #�}_`7 `II( 50C1 — Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name R?New business
Business Name/Type- � A r't 31 C i � �- �� S/ (� ✓`r
Previous Business on this site lrrtcc^i_ {�:. ; 4.t [Jn:�K . ^�( fG , r't c^ _ 4 M44/
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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: Z- e"y'X' rrr 1 jl - �, , i! �pj :nW
"This Clearance will onh be valid on the parcel for which it is approved. If you change, intensiA, or move the use to a new location, a new Zoning
Clearance will be required.
I hereby eerti*- that I own or ha,6v the o r rmission to use the space indicated on this application. I also certify that the information providcd
is true and accuta�s�the•brevofmy kno� •led e. I have read the conditions of approval. and I understand them, and that 1 will abide by them.
Signature JJ Printed zc L e' tt Ii-
APPROVAL INFORMATION
�Q Approved as proposed [ ] Approved with conditions [ 3 Denied
[ j Backflow prevention dcvicc and.aor 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.
Votes:
Building Official Date 1 d
Zoning official 2L�Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5932 Fax: (434) 972-4126
Revised 1 1 °1.20I5 Page 2 of 3
Intake to complete the following:
Y 4
Is use m LI, I II or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
, ' ` ,,
Will there be food preparation?
If so, give app]icant 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 public water2
If private wcll• provide Hea Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that apses
Is parcel on septic o public sewe
Reviewer to complete the following:
Square footage of Use: /{000
Yrlr
Permitted as: ; 0+411 _
Under Section: s Z/'
Supplementary regulations section:
Parking formula: /
y ao
Required spaces: C�
Y -
Items to be verified in the field:
N
ill you be putting up a new sign of any kind? Ifso, obtain proper
Sign permit.
Permit # inspector • Date
N Notes:
ill there be any new construction or renovationO
If so, obtain the proper Permit.
Permit # 2,bf 4 - (3 4r7 A i
Zoning to complete the following:
� solo ns:
Yi I
if so, ist:
1 Proffers:
Y'
Ifso,t;ist:
'Ta n*2n
Y (9
If so. List:
SP's.
If so, Lisr.
Clearances:
SDP's
Revised 111`2015 Page 3 of 3