HomeMy WebLinkAboutCLE201700155 Application 2017-07-20npplication for Zoning Clearance
CLE #Q
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Z-7"1-1 Date: L?- Z"]- 177
Receipt # I I p at, -A Staff:_
PARCEL INFORMATIO .yy
Tax Map and Parcel: -1 a yTj Existing
Zoningj
Parcel Owner:' q(p Q S V1/1,6m, LL(_
Parcel Address: S15 Rio F.,a4t Ct- ,(�A` .(� k City ckwtState \/A Zip ZZgIo
(include suite or oor)
PRIMARY CONTACT
Who should we call/write concerning this project9 uw nt--12a bN
Address S� City � V i � �� State ZiPL7,70 I
Office Phone: 156Cell # Fax # E-mail S U 0.l 1p, l f 0 ";
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: R of C._. alyc I kt ray , L—LC.
Previous Business on this site 01 W
Describe the proposed business including use, number of employees, number of shifts, vailable 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. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I o n r have the owner's permission to use the space indicated on this application. I also certify that the infonnation provided
is true and accurate t best of my knowledge. I have read the conditions of approval, and 1 understand them, and that I will abide by them.
Signature Printed �(/1ZQ h M x2 cl 1 It
AP P VAL 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 C Q
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/N
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
Wi 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 publ cDwatr?
If private well, provide Healthnt form.
Zoning review can not begin until'we receive approval from Health
Dept. FAX DATE
Circle the one that applDes
Is parcel on septic or pr?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. �j • ,
Permit # n p �/'if/►r/���'_
Y /
Wil re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
f •,
'Square footage of Use: /
Yr N
ermitted as:46U—,--j
n j
Under Section: z s . -A , A ' `
Supplementary regulations section:
Parking formula: 3'M V14
Required spaces:
Y/N (�
It s be verified in the field:
Inspector : /Date:
Notes:
Violations:
Y/N
If so, List:
^offers:
fY//N
`Tf so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so,tist:
Clearances:
SDP's
Revised l 1/1/2015 Page 3 of 3
O,L!EAOI I • 1515
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