HomeMy WebLinkAboutCLE201700143 Application 2017-07-28Application for Zoning Clearance
CLE #Mo.
OFFICE USE O LY
PLEASE REVIEW ALL 3 SHEETS Check # Date: -)
Receipt # 1hog qq Staff: ;
PARCEL INFORMATION l _
Tax Map and Parcel: ! r� 8 (D Existing Zonin M
Parcel Owner: S :P"tc_ �� ,t7 �1J0 t7D C' f a, .9V
Parcel Address: P.Lo `�'$ �lO G �_ City A u i State OL Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?V.) 61'6-JL�l
_11 l "
Address :_ Z 7S, ( � �� ,��City .F 1 A a State Zip �J
Office Phone: —Z Cell # 53— 8' Fax # E-mail CV�CGL� O_Co yyL
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of na New business
Business Name/Type
Previous Business on this site
Describe the proposed business including use, number of em to es, u
uem r of shifts, available par spaces, nu ber of
vehicl s, and any additio ate' rm io that 0 can pr p e: ' ; 7' p
O
*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 ot
e the o er's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to my kn ledge. I have read the conditions of approval, an�Yu er, tand thh , and that I will abide by them.
Signatur Printed �e1J r_ r (.e
APPROVAL INFORMATION L�
�[J 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 %[41"1 1 Date
Zoning Official �" &-- / 4�'P ( Date
Other Official U Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11 A /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/N
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 o public wa r?
If private well, provide Hea Departm nt form.
Zoning review can not begin unto receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or ublic sewe .
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the propel}- Permit.
Permit # 2a /7 --/3 C %
Zoning to complete the following:
Violations:
Y / ,qIf so, ist:
Varia ce:
Y/
If so, List:
Clearances:
Reviewer to complete the following:
Square footage of Use: -.79/�
3 / N Ars
Permitted as: (Ff fiCc Wa
Under Section: JA'9n/1 apO , p4fk (.0
Supplementary regulations section:
Parking formula:
Lug
Required spaces:
Y / >
Items to be verified in the field:
Inspector : Date:
Notes:
troffers:
/ N
If so, List:
SP's:
6 / N
If so, List:
SDP's
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Revised 11/1/2015 Page 3 of
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