HomeMy WebLinkAboutCLE201700054 Application 2017-02-28Application for Zoning Clearance'`"`'
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CLE # 400 O o v� y
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# Date: 2-2-6--) }-
Receipt # Staff: S
PARCEL INFORMATION
Tax Map and Parcel: OV9*jr,1-0,S Existing Zoning 11 �
Parcel Owner: t ( ��
f
/
Parcel Address: �a '75 sea,(,, i,�� L i1 City o U j 1 I State �d
Zip
(include suite or floor)
PRIMARY CONTACT Who should d',
we call/write concerning this project? _ / i a, -'a4VL'
Address: ��S ''u-i Ly1 City C-L" ��(,) J—State ✓67
Zip 22�
Office Phone: 7e- `fs Cell # 411, 6-3701 Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: /-c
Previous Business on this site Flo
9
Describe the proposed business including use, number of employees number of shifts, available parking spaces, number of
vehicles any ,1fidn al info r anon tha you can p ovide: Lads / ►.-•�•� ," ll
*This Clearanc ill only be valid on th parcel for which it i approved. If you c nge, inten or move the use to a new location, a new Zoning
Clearance will be required...
I hereby certify th own have the o er's perm' ion to use the space indicated on this application. I also certify that the information provided
is true and ace ate to t best of my wledge. ave read the conditions of approval, understand them, and that I will abide by them.
Signatufe7l, Printed > '� lY�u-V- I c
APPROVAL INFORMATIO
Approved as proposed [ ] Approved with conditions [ J 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
Zoning Official
Other Official
Date C
Date `112-71217
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/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/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 o ublic a er?
If private well, provide Health rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that aplies —�Is parcel on septic ublic se er?
Y /
Will ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/�
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:
Y/N � ,
ermitted as: tii - ,A l ,qy e,a
Under Section: Z
Supplementary regulations section:
Parking formula: J
Required spaces: to
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Viola 'ons:
Y/
If so, ist:
Proffe s:
Y/N
If so, List:
Variance:
6/N
If so, List:
SP's:
Y/ I)
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3
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