HomeMy WebLinkAboutCLE201700226 Application 2017-10-18Application for Zoning Clearance
CLE # 2o 1-7 6 6V i(
it
-
OFFICE USE ONLY ���55
Pe
PLEASE REVIEW ALL 3 SHEETS
Check # Da ! o'// 2 vn
Receipt # F'T'ill OS ,Q 2$taff: GYI,..s-.
PARCEL INFORMATION
Tax Map and Parcel: C961 Q --� (d - 00 —10 1 Q Q Existing Zoning G 1
/\N
Parcel Owner: ,tf// 4 V %1 // fit S
'' '
Parcel Address: 'qe .eso' � � Cfity (,d�tF"OUJzs/i/40 State Zip�'�` 90
(include suite or floor)
PRIMARY CONTACT nn
Who should we call/write concerning this project? 17� 6Ut dt SCE
Address: ) Z/ � Ve,4 Aq1 A 4 r 1. City (�42/0/j;4'.J1l A6tate �/`'r Zip
Office Phone: l ' - �) O� a 01 Nell # Fax # E-mail
7 T3- q, D - ail a
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ew business
j�
L L
Business Name/Type: Zuxp l�C��/Q� Roq-/ 6 ,NJ
Previous Business on this site
Describe the proposed business including use, number of employee , number of shifts, availa¢le� arkin spaces, number of
information
vehicles, and any additional that you can provide: �,d Vee
*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 1 own _ have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accur t the b st of owledge. I have read the conditions of approval, and I understand them, and that 1 will abide by therm.
j� C.ct_
Signature f �l� Z-a
Printed
APPROVAL INFORMATION
[L4`Approved as proposed [ ] Approved with conditions [ ] Denied
[ IpKkflow 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 Date 0�1
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
Revised l 1/02/2015 Page 2 of 3
Intake to complete the following:
Y /6p,
Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 orCblicwaterIf private well, provide Heaient form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or ublic s er?
Y /
Willobe putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Wil re 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: 5 0— i 4 Z
Y/N
ermitted as: 0
Under Section: Z.Z. 1 Z . I
Supplementary regulations section:
Parking formula:
-- ll�mnic�e� +'/cliri+
Required spaces:
Y N
Item o be verified in the field:
Inspector : Date:
Notes:
Vio ns:
Y / N
If , ist:
Pro
y
If so, ist:
Var' n
Y N_
If so, Est:
SP's:
If /'N1s
If so, ist:
Clearances:
101 -3 V
SDP's
Revised 11/1/2015 Page 3 of 3