HomeMy WebLinkAboutCLE201600093 Application 2017-01-10Application for Zoning Clearance
CLE # a)U J to —9.3
OFFICE USE ONLY .
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Q Staff -
PARCEL INFORMATION
Tax Map and Parcel:
Parcel Owner: 'J U �
Parcel Address: .S `+(� LA r I
Existing Zoning 12tu �� C
Zip
(include suite of moor)
PRIMARY CONTACT
'
Who should we call/write concerning this project? 61
L
Address : �y � -- tszn City Gr0 State , Zip,?_M!
Office Phone: ( ) Cell #SftO # E-mail ert� 2�_z,44,", ,D
City
State
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
to
Business Name/Type: 5
t-",
t �-
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: .. L-Lu ( L, 0
*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 accurat A,,the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature iA Printed
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
Zoning Official Date y�r b,l,
Other Official Date
%,aunty ui Amemarie Lepartment of c-ommunity Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/1/2015 Page 2 of 3
S
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.
YY/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 ublic water?
If private well, provide He epartment 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 public sewer?
Y 'V
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y 10
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: 5 �(
(yJ / N
Permitted as: d c c g SLQ—Y
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
YY /0
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/�
If so, List:
Proffers:
I'/N
If so, List:
,z-4 Ca y — Zy
U54 --'-j
/y -
�S
Vari ce:
Y/O
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 1 ] 1/2015 Page 3 of 3
F/a-)P- Plc�L.