HomeMy WebLinkAboutCLE201700169 Application 2017-07-24Application for Zoning Clearance
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CLE # hbJq. (Iq
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PLEASE REVIEW ALL 3 SHEETS
OFFICE EON Y
Clwt # Date: -
Receipt # Staff: AM
PARCEL INFORMATION
Tax Map and Parcel: / / _- y Existing Zoning
Parcel Owner: 5<A",r h-& t_ W i"
Parcel Address: 410 pa&mi ER ci (Z City c H A P Lat r syo StateZip Z,25to J
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? JG(2 ISH i PArC- L_
Address: ty i o P aen� o E2 c i FL City rAg A 2t=rT0y % uC— State Yam-- Zip 93�� J
Office Phone: (43H) Cell # y,�k.ygd-"2- Fax # ►-t3,4-`r't6---9@6j E-mail RoY4L1n)N 41t(,!:rZCio"WL . CC
APPLICANT INFORAIATION
Check any that apply: Change of ownership Change of use Change of name ieNew business
Business Name/Type: Rout- it"A) MO`rEL
Previous Business on this site —
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, umber of
umber
vehicles, and any additional information that you can provide: lam. S � Pt-o a C-E 51+ i pes
o PnxKi my .Sood-
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*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 read the conditions of approval, and I understand them, and that I will abide by them.
Signature 1-< . 8 Printed 1'< a ►SH 1 P Are L
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, 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
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 use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y / N�
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 publiwater?
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 /(D
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /E Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: Z j, &')
6)/N
Permitted as:/,� �c✓f
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y /
Items to be verified in the field:
Inspector
Notes:
Date:
Violations:
Y/6)
If so, List:
Prof rs:
Y/ Ok
If so, List:
Variance:
Y / 'L
so If , ist:
SP's-
Y / �1
If so, List:
Clearances:
SDP's
Revised 11 /1/2015 Page 3 of 3