HomeMy WebLinkAboutCLE201700208 Action Letter 2017-09-12Application for Zoning Clearance
CLEC) t o] _0'�--
J
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY /
Check # Date:
Receipt Of-tf o 5_:�/' /b VOStaff: vlL
PARCEL INFORMA(lTION 1 1`
Tax Map and Parcel: O l C1 Existing Zoning
Parcel Owner: a (� v
Parcel Address: .2o)3 W O0&_VV k- (� Ik City W" I.34ate VA Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
fi ,� toe �Q
Address : D lei �' ( Y� City i GLY' S 0 i V A Zip / i
0
Office Phone: O Cell # l --3�Fax # E-mail Yd x
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: A � (,(*c � chz
Previous Business on this site SlN"
Describe the proposed business including use, number of employees, number�q°� shifts, av ilable parking spaces number of
vehicles, and any additional information that you can provide: ACLL+Vr1C7Wi-Q ► 5 �
*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 infonnation 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`Printed ll i/L►i 1
APPVVAL INFORMATION
[ proved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x ]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 complies with the site plan as of this date.
Notes:
Building Official - 2 Date elv/ -/-7
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
1
k
2-M
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y P-1Is use inI, 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 o ublic wate
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o ublic sewer?
Y/fv
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y %�
Will there 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: (y , S< P::7- /
N
rmitted as: Ake- e- , picfo6f1g
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y N
Item o be verified in the field:
Inspector: Date:
Notes:
Vi s:
Y/N
If so, ist:
fers:
Y N
I so, List:
1_4 A ii11 Z5
iance:
Y N
so, List:
�I i9q- Zq
SP' .
y
If so, ist:
� �tn0
Clearances:
2017-1�7 �47
SDP's
�v14- 18H �
l�lq — i1Z
201- 1 - 0 Ib S
Revised 11/1/2015 Page 3 of 3
IJ-
jj! -1
all
.--- A
C/a VA? 2,51
pay- k -'n J/
m