HomeMy WebLinkAboutCLE201700106 Application 2017-06-09Application for Zoning Clearance
CLE #
OFFICEL*_Ls
L
PLEASE REVIEW ALL 3 SHEETS Check a(_- Date: • -I _q
Receipt q Stoff:
PARCEL INFORMA'POp� �'
Tas Map and Parcel., _D(4>1 W(J- O3-00- C�01 __ Existing zonine Ne ��et�,!__
Parcel Owner: 1 T `�V �� C� ���� �:i 1C�
Parcel_-�( ��_(80 city ��o�ku„��- State �j '� _Zip ZZ O
(include suite ur floor)
PRIMARY CONTACT Who should we call/write concerning this project? _1�A(Ak—AA J0,; ,nC� -
Address: ��' A �} ,�City
Office Phone: Lvj5 -&& Cell p __ _ Fax 4 y E-mail
ArrLlc:Aiy ' 1NFUKMATI
Check any that nnnly: X Cis
- IN) C- __ zip 2Ltn
of ownership Change of use _ �_Changc of name New business
Business Namefrype:+� �, (ypttfgn to
Previous Business on this site —
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehlcles, and any ndditlnnal information that you can provide:.
'This Clearance will tray be valid or, the parcel for which it is approved. If you change, intensify nr mnvc the use to a new location, a nrwZormg
Clearance will be required.
hereby eenify fitt I own or have the /tttner> pcnnission to use the space indicated on this appliratien. I also rci ify that the infbrmstion provided
is True and ntcur a to the hrsl of nt1 �itnordtte. I hone read the conditions of approval, vid I understand them, and Ihrt I will abide by t}tan
e
Sign
Prime cis�GtG, U h0.C7C`,
APPROVAL INFORMATION
Approved as proposed I I Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-431 I, x 117,
( ] 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 Offic
Zoning Official
Other Official
Date
Date !6/2/z-o i -
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 %Iolce: (434) 296.5832 Fax: (434) 972-4126
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y
Is us LI, H1 or FDiP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y' N
tll 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 wel public %%aler
If private well. provide Hca epunrncnt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX AA1'13 _A__
Circle the one that apph
Is parcel on septic prijublir sewer?
Y/N
Will you be putting up a na% sign of any kind? lfso, obtain proper
Sign permit.
Permit q
1 rl C l there be any new construction or renovations?
If so, oh�y �tfi4 p�(j nt
Permit # li-V1i I.m� a
Zoning to complete the followine:
If —E
If sooi, sc
Va ri
Y /
Ifso,
jReviewer to complete the following:
Square footage of Use-
Y , N
Permitted as: �Y,ti✓' 1,� J'�
Under Sectiow 0
Supplementary regulations section:
Parking formula: /
Requxed spaces:
V /(/
hems In he verified in the field
Inspector: Date:
Notes:
VY/N
so, List
Revised 1 1 1/20) 5 Page 3 of 3