HomeMy WebLinkAboutCLE201600040 Application 2017-08-27Application for Zonin Clearance
CLE # 261le -� -
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 3 3 Date: �- 93
Receipt # //} 3 a `i 3 Staff: %
PARCEL INFORMATION
Tax Map and Parcel: _ 18'- S E Existing Zoning N C
Parcel Owner: i?V--J c LC do r-iLNRy L1 SC <D e-0K AN J
Parcel Address: 13Zk Sttiwl POIt4-r— 12D City CblllQ.LA-Ve-IIA0 State V A- Zip'11Q�
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? _ �PM�� S Mt
Address • 3Sgo R Jc41! l SLI t-1 Qli� City'-WAkLQJ%T14vt _ State V 4- Zip24432-
Office Phone: (_� Cell #x # E-mai1ITME4-RONVQ Qqk(, Cali/
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name >�New business
Business Name/Type: —rpV TJ(3
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:
i ms t-tearance win only ne 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 wlPrinted -Z h*.klu KA • S P4 \'{-H
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
Zoning Official
Other Official
Date (�
DateL�f/� r�
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
J
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y /C
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. rJL
Y /&:::�)
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 r ublic water?"''
If private well, provide Dealt e a ent 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 ub i7 c sewers
Y
WiI u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permi� f,
0G C 7" 1
Y/N
W1 ere be any new construction or renovations? j
If so, o#i he proper Permit. .T --fjql S
Permitt#
73 P
f.onme to complete the tollowin
Violations:
Y/
If so, ist:
Vari ce:
Y/
If so, List:
Clearances:
Reviewer to complete the following:
Square footage of Use: NO-7
O/N
Permitted as: J j -�
Under Section: `Z Z
Supplementary regulations section:
Parking formula:/
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes: AdA
SP's
Y/
so, ist:
SDP's
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Revised 11/1/2015 Page 3 of 3
Page 1 of 1
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http://gisweb.albemarle.org/GISWeb/Showlmage.ashx?t=s&f=S0000047\SO023273 2/23/2016