HomeMy WebLinkAboutCLE201700038 Application 2017-04-12Application for Zoning Clearance
CLE # tQ�
1;-r
PLEASE REVIEW ALL 3 SHEETS
OFFICE U NLY
Check # Date:
Receipt # Staff:
PARCEL INFORM O OA
Tax Map and Parcel: - - Existing Zoning
Parcel Owner: 1
i
ParcelAddress:35-lj} Rems0y) f-t St•3City ('rbo-H k lleState VA Zipz2 ;?
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? kA i i y1
I
Address Ppa,\5m Ci, SadC.�li l City hbrjo vilkstate-VA Zip A,;
Office Phone: ( 220 - ZU0 Cell IFax # E-mail do n iSL I i(Q fd , 014
AYYL1k:A,N 1 IA UKN1A'J0N
Check any that apply: Change of ownership Change of use Change of name V New business
Business Name/Type: au Dortq / Pu l :E '- M f
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: �'� , <4
*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 accurate to the best of m knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature G Printed 1-1 m
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 Dater
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:
Y
Is J31 LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will re 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 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 obt'c sew—
Y /N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y �( N�
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonij4Lto complete the following:
Reviewer to complete the following:
Square footage of Use: 12
ermitted as:i
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
r
Notes:
Vi Oatio s:
Y/N
Ifs
Pro ers
Y t N
If .
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3