HomeMy WebLinkAboutCLE201700136 Application 2017-06-07Application for Zoning Clearance°FAQ
CLE #
� �RGIN\P
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # rj Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 07� 00 - 00 -ov 1 7 0 Existing Zoning
Parcel Owner: 1 t����c� S !,y j [ 4 G_
Parcel Address: 1OF s(�fNal� (R ��^�� City ejWti4((X=SJ.%/cr State (�'l Zip-49-N//
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? F ��� E t
PRIMARY
J Is h r� V� ��je otc� �ni v� City /dTl�� % State 1 ';i ZiP
Office Phone: ( 22) ' / f Cell # Fax # f 6'S7/v E-mail Virt�Tn;�l�_n�ccr,� �J
APPLICANT INFORMATION
Check any that apply: ff IChange of ownership Change of use Change of name New business
Business Name/Type:ck�L
Previous Business on this site A! brY-�Z y
! /
Describe the proposed business including use, number of employees number of s ifts, available parking spaces, number of
vehicles and any additional 'formation,tthat o(u can provide: 2 � tqo ,.y
0. e,
*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 my knowledge. I have r�d the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed S+ e V :. mE ,t
FiNo
PROVAL 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.
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 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y/O
If so, give applicant a Certified
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 or ublic water?
If private well, provide Healt Depa�itment 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 pu is sT— ewer
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Ming to c
Violations:
If /
If so, ist:
Vari ce:
Y/01
If so, List:
Clearances:
the followin
Reviewer to complete the following:
Square footage of Use: 4`
7
Ier/N
mitted as:
Under Section: L% _ 2,
Supplementary regulations section:
Parking formula:
Required spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Proffers:
Y /(D
If so, List:
SP's-
Y/
If so, ist:
SDP's
Revised 11/1/2015 Page 3 of
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