HomeMy WebLinkAboutCLE201700166 Application 2017-07-14Application for Zoning Clearance
CLE # v701:Z -/, oU
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # 2 �6 5 �J Date:
Receipt # Staff: I,
PARCEL INFOR AT ON
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Tax Map and Parcel: -flo Existing Zoning
Parcel Owner: 02,
Parcel Address: � City 0 State V Ti Zip
include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? �f}GHSE �p�17�Uc%/0�✓ �Afti1lE �Q�6/✓Gf�
Address: Ay , Suirr,�00 City c T State Zip?
3r3y
Office Phone: ( ) Cell # 7971 Fax # E-mail I-SXee/uD(d-Jr9clld., ,JET
APPLICANT INFORMATION
Check any that apply: Change of wnership Change of use Change of name New business
//
Business Name/Type: ,L . 6wf
-
Previous Business on this site --
Describe
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: lore- 1019d :moo, SQ
Ore ClsiSiL�coTioa!•
*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 inforniation provided
is true and accurate to the best of my knowledge. 1 have read the conditions of approval, and I understand them, and thatI will abide by them.
Signatur Printed —7,4x4ss
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, xl 17.
[ ] 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 7 2�
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 IQ
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will ere 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 ater?
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 o u lic sewer?
Y/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permi
Permit# 0/--Dl.36e—S
Y/N
Will there be any new construction or renovations?
If so, obt ' t re it.
Permit # .
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: /3 9%
3d/N
Permitted as: ►rei-A, I
Under Section: AL T/ d cs-, L. o
Supplementary regulations section
Parking formula:
Required spaces:
Y/5
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so, ist:
Proffers:
�/N
If so, List:
2w►�I 2� 1 �—�
Variance:
Y/P)
If so, ist:
SP's-
Y/&
If so, List:
Clearances:
SDP's 2
Revised 11/1/2015 Page 3 of 3