HomeMy WebLinkAboutCLE201700041 Application 2017-02-17Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date: l 3
Receipt # Staff:
PARCEL INFORMATION ,
Tax Map Parcel:
and
! u�j1 Existing Zoning
Parcel Owner: P LLC- NAIL Ac cl ,(�f J 1U J'_6
Parcel Address 611A t ' ( pity b �i U fe to -a Zip
(include suite or floor)
PRIMARY CONTACT ,r
Who should we call/write this
concerning project?
Address ! � 3�4x e d rGle
�/`�City Ile, State Zip��/�
Office Phone: (v - ell # l`3j E-mail
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of nameNew business
/Change
Business Name/Type�ie
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available par ng spaces, umber of
vehicles, and any additional information that you can provide: C1`OL`�s �X /1✓dG �e a7711 ;y A1,5;
*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 perrmss)aq to use the space indicated on this application. I also certify that the information provided
is true and a e to the best of my �Zieff.. I h ea the conditions of approval, and I and staryd them, and that I will abide by them.
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Signat Printed��le�vc' ✓` ;% / /'� //Y"7
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APPROVAt INFORMATION
Jyt] 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:
r
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/l/2015 Page 2 of 3
Intake to complete the following:
Is
Is u m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi 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 publ' ate .
If private well, provide Hea ent 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 per is s er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y Will eIN
re 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: / �4%
))/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula: /
Required spaces:��
Y /
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/
If so ist:
Proffers:
Y/+
If so, ist:
Variance:
Y/
If so, ist:
SP's:
Y/0
If so, st:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
-Ile 7 2- l0