HomeMy WebLinkAboutCLE201700127 Application 2017-06-01Application for Zoning Clearance
CLE # J
101
OFFICE USE ONLY
3 3 13�
PLEASE REVIEW ALL 3 SHEETS Check Al -�'Date:
Receipt # Staff:
PARCEL INFORMAT ON
Tax Map and Parcel: 3 Existing Zoning
Parcel Owner:
Parcel Address: ,
City, N-state V Tf 'LlpMq
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address :_ 703 /_ f{ Pr�,N SY City / cafe 01 Zip,'12
Office Phone: (__J Cell # �/�y-�'l /9/O Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Nnme/Type: � (A , 17
Previous Business on this site
r
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:
'This Clearance will only be valid on the parcel for which it is approved. lfyou change, intensify or move the use to a new location, a nckvZoning
Clearance will be required. ,
I hereby certify that 1 own or have the owner's permission to use the space indicated on this application. t also certify that the Information provided
is true and accurate to the best of my knowledge. 1 have read the c nditions of approval, and 1 understand them, and that I will abide by them.
Signature Printed �_In v r c� C��c.a] v) r _
rJ
PROVAL INFORMATION
Approved as proposed [ J Approved with conditions j J Denied
[ J Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117.
[ J 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 rnc, ate 513c) r1
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Is u c n LI, Hl or PDIP zoning? Ifso, give applicant a Certified
Engineer's Report (CER) packet.
YIN
ill 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 ,
1s parcel on private well or li ter?
If private well, provide Hea artment 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 p !ic se '.
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit N --
1f so, obtain proper
YIN
Will there be any new construction or renovations?
Ifso, obta' the pro rmit1..
Permit 4
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
CV / N 1
Permitted as: i it ,M e-4
Under Section: 2—
Supplementary regulations section:
Parking formula:
i pl;4 V.
Required spaces:
Y/
Items to be verified in the field:
Inspector • Date;
Notes:
Viola ons:
Y/(NI
If so, List:
roffers:
/N
If so, List:
Variance:
Y / (D
If so, List:
(Y/ N
If so, List:
'
ibis � 2�
Clearances:
SDP's
Revised 11/1/2015 Page 3 of3