HomeMy WebLinkAboutCLE201600221 Application 2016-10-12Application for Zoning Clearance:
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OFFICE U ONL
PLEASE REVIEW ALL 3 SHEETS Check# Date:
Receipt # staff: .
PARCEL INFORMATIO ,.�
Tax Map and Parcel: "-' C) 1 .- Existing ZoningDAnbpwn-
Parcel Owner: 1 �' �� .,� ] L [ 4
Cl
Parcel Address: S`Zy0 Th r". .AJrWcj &J.- City _ CralxAlf State I& Zip Z V?
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? saSah 1 k1 (J
Address :ky?$ 1` &V W *• rJ J)Y 1 V-r. _city_ (ter oz State 1f at Zip ZZQ 3
Office Phone: { 01- 6,304Cell # Fax # E-mail Micdtl Sin gn 1Q j . iyiC • L o
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: -_S uir 4 Tkip 4*UJ= a. & ill _
Previous Business on this site— liq t r- AlAcU r) 0-rill
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: A ray *%
*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 Printed a45a), j&74k jZaZt4rrhJrJ _
APPJkdVAL INFORMATION
[L4oApproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Baclflow 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
Zoning Official Date
Other Official tTV Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y l0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /J N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not be#MM,
eive approval from Health
Dept. �r DAIE
Circle the one applies
Is parcel on private well or public water?
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 or public sewer?
Y J/ N
dill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / N
Will there be any jcnstructionlor renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete th}e follo
wing:
Square footage of Use: 01�
ermitted as:
Under Section: fJl 7
Supplementary regulations section:
Parking formula:
Required spaces:
E
lt
I e verified in the field: /
Inspector • Date:
Notes:
Violations:
YIN
If so, List:
Pro er
Y I N
Ifs ��
}
Variance:
YIN
If so, List:
SP's:
YIN
If so, List:
Clearances: !]r � n ` rD �n� �
SDP's
Revised 11/l/2015 Page 3 of 3
JUL.22.2005 3:46PM FEIL PETTIT WILLIAMS N0. 704 P. 1