HomeMy WebLinkAboutCLE201700014 Application 2017-01-30Application for Zonin Yearance Ti,11
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OFFICE USE O LY � C`7' ,/
PLEASE REVIEW ALL 3 SHEETS Check # y Date: 16
Receipt # U U Staff:G ✓1/
PARCEL INFORMATION Tax Map and Parcel: �j �o / �C� m (,10 — D j '� `� d Existing Zoning (la 41,,V efl e ° -1
Parcel Owner: V C— yY !' I 1
Parcel Address: 1 �� 2 �� � i`� b(�City _ r�, �Us State V)k Zip 12-`t6
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: � D of 3t�i , j�
2.- � w Sk � ,. R \�T City , Z' State
Office Phone: (___) Cell # t _?y/3 "Z 2a l � Fax # E-mail l ,l
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: \ r ) r r
a
i
Previous Business on this site 0_ ,\ 7� , �A
Describe the proposed business including use, number of employees nu er of shifts, available parking spaces, number of
v hi Ie qd pif additiona information that on can provide:
k rya(1, o 04t^� 't v>^ k i s
*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 t own r have the.owner's pe is 'on to use the space indicated on this application. I also certify that the information provided
is true and accu e t the est f my ledge. ha rea the conditions of approval, d I understand them, and that I will abide by them.
11
Signature tL"- 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 t 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 11/1/2015 Page 2 of 3
Intake to complete the following:
Y/L,
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi t ere 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 ublic 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 ublic__ _sewer
Wi/Fbe putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Wil(tere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followinLY:
Reviewer to complete the following:
Square footage of Use:
/N ,)
Permitted as: A4 c,.,j/ Litt ; %✓
Under Section: i 7 • Z • 1
Supplementary regulations section:
1
Parking formula: '
Required spaces:
Y/
Items to be verified in the field:
Inspector :
Notes:
Date:
Violate ns:
Y/N
If so, List:
Profferf
Y/(NI
If so, List:
Variance:
j? / N
If so, List: f ! f
f
SP's:
Y /;,
If so, List:
�
Clearances:
SDP's
�;— M,
Revised 11/1/2015 Page 3 of 3