HomeMy WebLinkAboutCLE201700025 Application 2017-02-15Application for Zoning Clearance
CLE # Q % `,25
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # o? 103 Date: 31 I-1
Receipt # 10� l0�10 Staff: JP
PARCEL INFORMATION n
Tax Map and Parcel: (0 W -_01- 0A - 9h n I Existing Zoning_ )
Parcel Owner:/ IIYIln9J lOn !�!// �l/C� n arc / n,.�/�n_ 14 .
I --
Parcel Address:_ Q O rr1 ,� p�rCityNyW&1J11 State V Jq Zip
U 1 (incl de su' a or fl f r) rn t ZZ
0 J
PRIMARY CONTACT
Who should we call/write concerning this project?
/o/ /
Address • �3 0c) " Vrt w� Yeti r. City -s : !Mate A- Zz� O / zip
�,
Office Phone: .3 S'S_
L ) Cell 0 i 7 Z Fax # E-mail d4 0Ctyl 14 G-AUL 1 c 5 t,J
I APPLICANT INFORMATION
Check any that apply: Change ofownership
pChange of use Change of name New business
Business Name/Type: ✓C1 � i�1 �1 �CX�L, L C, S'LcJ / 1 �-
Previous Business on this site
Describe the proposed business including use, number of employees, n tuber of shifts, available parking spaces, number of
vehicleynd agy�additional information, that you can provide:
U_ t> I �� l lt_5 . .1 ✓ , ✓rM_,f Cam^
*This Clearance ll my e valid on th6 parcel for v#iich it ig appr ved. If yoV chiffige, intensify or mo4j the se 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 an accurate to th , best of rn Atnowledge. I hau ' read the co ditio of approval, and I understand them, and tha� I will abide by them.
/
Signature Printed Gl V ✓! vt� 6
APPWWAL INFORMATION
[kXpproved 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
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
Is us I, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
WilI`th
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 or cih-77epurtMent
water?
If private well, provide Hea form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app ' s
Is parcel on septic o blic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. -
Permit # S V-1M
Y / N P- "' rn-t, '-
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin
Reviewer to complete the following:
Square footage of Use: J
�� p�
Qm�tted as: 6R �
Under Section: (A01
Supplementary regulations section:
Parking formula:
Required spaces:
�N
,ns to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
LOSM vINISHIA'3n1A331-lOIHVHa 3/VHa H31H9N33HEJ OK
�O = ,4 T :3jva3 91OZ 9Z LO:aLva
VA '3-1-IIAS❑11❑-laVH3
�D
O�
tilaqW
w.ao "`°� "� o„o —.—OW
a3llnruao� N3ISRJNO:AeNmvHa
o
%upy
AlilnN 3NW AM
a�L3�g
LoL 3lins
[�)
:ie :31va
037WJBNI mH91NUrIA • 111f16 • CMN0133O
83IN30 SS3NWG H1lV3MNONV400
IL
a
w
:sNo1s1n3H
NOI-LVHOd»OO SNOUTAN3 NJIS3O
:3wvN 1a3roHd
a
_
O
I
I
j
W
V) CV
I �
I
I
I
I
I
I
I
I
I
I
%
Jv
CD
II
Q
I
�
O
p
W
w
W
C/)
Q
Q
O Cl-
U
U cn