HomeMy WebLinkAboutCLE201700211 Application 2017-09-14Application for Zoning Clearance
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CLE# �-°A1
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OFFICE U Y
PLEASE REVIEW ALL 3 SHEETS
Check # Date: -
Receipt # Staff:
PARCEL INFORMATION/ 43— -A I
�1occ Existing Zoning Kh
Tax Map and Parcel: 'etU 4l l 014-4 143o Ct L
Parcel Owner:�-
Parcel Address: 2 Z l,- Fo"�e-1 7E&c-L City State V Q Zip Z
(include suite or floor)
PRIMARY CONTACT
le 1!�
Who should we caWwrite concerning this project?
Address: 221 -!;— 4K I -e-l101— T (ra-r-k City State 1/� Zip —Z2-9 el
Office Phone: ( ) Cell # Fax # E-mail yypL6P(71e1dP
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 6 `r >C�1� �� i 1101g)
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:
*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.
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 I have read the conditions of approval, and I understand them, and that I will abide by them.
knowledge.
Signature .�c1w.�� Printed
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, 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 complies with the site plan as of this date.
Notes:
Building Official Date Y
Zoning Official Date %/ / %6
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
0 ►y
Revised 11 /02/2015 Page 2 of 3
Intake to complete the following:
Y /
Is u LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wil ere 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 oZappIs parcel o well or ublic water?
If private well, provide ealth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the�lies
Is parcel se tic or ublic sewer?
Y 6
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /1'th Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followinp,:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as: NA1 we O
Under Section:
Supplementary regulations section:
SP M6-►o
Parking formula:
Required spaces:
Y
Ite o be verified in the field:
Inspector : Date:
Notes:
Vio ons:
Y/IN
If s , ist:
Pr s:
Y/N
If sb�List:
Va ce:
Y / N
If3`e!I_ist:
Y N
Ifso List:
MO
j(I
Clearances:
SDP's
Revised l I /] /2015 Page 3 of 3