HomeMy WebLinkAboutCLE201700154 Application 2017-07-14Application for Zoning Clearance
CLE # 15q
A, f
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 17-14 Date: 0.
Receipt # _] I d) 3:5 Staff:
PARCEL INFORMATION
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Tax Map and Parcel: (i�%M I Z- — �,b O'Z. Existing Zoning
Parcel Owner: /?j G h a" -,/ f-/ • CL 1tl�
Parcel Address: 673 4r Cyc (e- City�y`b, p (d alb State UP Zip ZZ D
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? ,�/ �F11`o6n* 6-i y Hrz
Address :/U `% QGC -C'� C'_� City S+,2{.O s e2ot j State U9 Zip�(vsS
Office Phone: V / -31e&ell # S 0 ,rr%_P_ Fax # E-mail ?
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name /New business
Business Name/Type: Carp bi (--Q
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: Z A0 LA\ O-C� Csz SAnO�7
*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 the best of my knowledg I have read the conditions of approval, and 1 understand them, and that I will abide by them.
Signature PrintedEji/t�2�3 , ,r
APP1f0VAt 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 Date /
Zoning Official Date �� b1zoJ7
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
M5
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /C)
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 public 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 or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the followinLY:
Reviewer to complete the following:
Square footage of Use: '9 '7/0 5f:'
YJ/N
Permitted as: cc C'�O
Under Section: Z57q.
Supplementary regulations section:
Parking formula: �O/O
aVv4
Required spaces:
Y /l1
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/A
If so —, List:
Proff s:
Y/ 1E
If so, List:
Varia e:
Y / V
If so, ist:
SP,sj
Y / N
If so, ist:
Clearances:
SDP's
Revised 11/1/2015 Page 3 of 3