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HomeMy WebLinkAboutCLE201700204 Application 2017-09-12Application for Zoning Clearance;°�� CLE # 2_ v 1-7 0O Z041 �IRG�NP OFFICE Uffl�Y Check # Date: PLEASE REVIEW ALL 3 SHEETS Staff: Receipt # PARCEL INFORMATION Tax Map and Parcel: 0 5 Z 00 — 06 —00 — 0 9 ( P E Existing Zoning P pS C_' Parcel Owner: _ftmY (ryv od Commy6 LC, -211 Y Parcel Address: �� 7 />Q���61 City f State vl Zip (include suite or floor) PRIMARY CONTACT I �— e l r lit Who should wecall/write concerning this project? Address : ®� t �4kd4 City - r 1l e— State Zip Office Phone: Cell #�3 Fax # E-mail h �/�`%� S '0 A APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: Previous Business on this site Describe the proposed business including use, number of employees, n mber of ;hifts available parking,spaces, number of vehicles -and an additio al information that you can provide: *This Clearance wi'll 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 certif at 1 own or have the owner's permission to use the space indicated on this application. 1 also certify that the information provided nderstand them, and that [will abide by them. is true and acc to tot e best of my knowl e. l haye read conditions of approval, aye'le� _ j � C Printed C, Signature • AptR6VAL INFORMATION [ Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117. [ ] 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: � 'J' Building Official '�" Date dlZoning I 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? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wil 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 ublic water? If private well, provide Health epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the the one that applies Is parcel on septic or lic sewe . Y 6 Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /1`tlf Wil ere be any new construction or renovations?. If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: footage of Use: 2sS— Permitted as: l'Y►P41(a l CORI i f U5f Under Section: Supplementary regulations section: Parking formula: 1100 nd- Required spaces: Y N Ite o be verified in the field: Inspector : Date: Notes: Vi ns: Y/N If st: ffers: Y/N so, List: Va ' ce: If N If so, ist: SP's: If YO,ist: Clearances: O+jr ask u /6V nP eS SDP's 2 t) izGo ©-LLj aw:7-91 j 7S; 2U17 2v1b 2U16—ZLL Revised 111112015 Page 3 of 3 Cieec��l-117 7