HomeMy WebLinkAboutCLE201700160 Application 2017-08-29Application for Zoning Clearance
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OFFICE US NLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # tiff Staff:
PARCEL INFORWTION
D 0 761 00 - UCJ - U 17 +
Tax Map and Parcel: -f- - Existing Zoning
Parcel Owner: �: " ` 7F (-'r ler r'G
Parcel Address: �� Q 66. � ` ' ' 7,• v l �,� City State p _ �� Zip
(include suite or floor)
PRIMARY CONTACT
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Who should we call/write concerning this project/?�
Address: rr�2ve �7' City zz State `�%� Zip Z
Office Phone: Cell ##G i �� �dFax # E-mail O �+" �C`° �"?A' tIfl,•
C o ti,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business NamelType: M 0 ►c�7 (4'' i 5 /l � i— Gin, ��. r yG�
Previous Business on this sitey�
Describe the proposed business including use, number of employ number of shifts available g spaces, number of
vehicles, and any ad�nal information tha ou can provide:
1�4
'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 owners permission to use the space indicated on this application. I also certify that the information provided
is true and accurate a my knowledge. I have read the conditions of approval, and I understand them, and th�ajt I will abide by them.
Signature Printed _. ''ln rI Q�
APPR AL INFORM TION
proved as proposed [ ] Approved with conditions [ ] Denied
Baclflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ ] 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 c mplies with the site plan -as of this bate.
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Notes: l D
Building Official Date
Zoning Official T11 11,4 Date' 1
Other Official IV Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Intake to complete the following:
Y/N
Is use in LI, H1 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 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?
Reviewer to complete the following:
footage of Use:
n- W4 oly[Ij
rmitted as: (
Under Section:
Supplementary regulations section:
Parking formula: ) 13 ArLo
Required spaces: 5
Y
Ite / N rL
be verified in the field: 0 "�"�
Y/N
Will you be putting up a new sign of any kind? if so, obtain proper
Sign permit.
Permit # Inspector • Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonins to complete the following:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances: fi L�
I
SDP's
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Revised 7/1/2011 Page 3 of 3
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