HomeMy WebLinkAboutCLE201700234 Application 2017-10-20Appli"catflon far Zonling Clearance
A1*1
CLE #
ti
OFFICE USE Olt ' T —`
PLEASE REVIEW ALL 3 SHEETS
Check # (t� 3 .:.� Date:
-- �_.
Receipt # j -s,- c Staff: �y
PARCEL INFORMATION -- -- -
Tax Map and .Parcel: i, jW A "Z Existing Zoning C.-)
Parcel O«ner: tY1 l7s ur7 x.� i L�
Parcel Address:i t �' Cite t_(.)i {ram State ri Zip
-
-
(include suite or floor)
PRIMARY CONTACT
Who should we call write concerning this project? - �; {" /� �L ✓V76 +y --�'---
AddressCray t'4 { State G11 Zip�_ySt�
Office Phone: ea- } C3 Cell # _4 Fax # E-mail
APPLICANT INFORMATION
-check any that apply: Change of ownership - Change of use Change of name � New business i
Business Name/Type: �+f CL.�.tt %: �.i.1 7 A L 4 (—
P!'evious 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: t._ h t s ! rry 3 ! i C
x"Tlus C"learanee ),sill only be valid on the parcel for which it is appraVcd. If'}nu change, intensity or move the use to anew location. a new Lnning
Clearance will be iv.quired.
I hereby certify that I own or have the owner's pennission to use die space indicated on this application. 1 also certify that the information provided
is true and accurate to the best of my knowlglge. I havv read the conditions of approval, and 1 understand them, and that I will abide by them.
Signature
APP VAL INFORMATION
[ A, pproved as proposed [ ] Approved with conditions ( j Denied
( j B, ckflow prevention device and/or current test data needed for this site. Contact AC'SA_ 9 77-451 1, sl 17.
I. Vot physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
E j This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official 4 Date �� t
Other Official r Date _ to
......... .......... _____..___.............. ___�_.�-__.—____._
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 Pate 2 of 3
Intake to complete the f'ollowi.ng:
Y "P
Is use Jn U. II.I or PDIP zoning? If so, give applicant a Certified
engineer's Report (C'1 eR) packet.
will ere be food preparation?
If so, give applicant a health Department form.
7.oning review can .not begin until we .receive approval from Health
Dept. FAX DATE
Circle the one that applies -- - -
Is parcel on primate Vvell ublic w
If private well, provide Ilea t . apartment fo m.
7oning.review can not begin until we receive approval from health
Dept. FAX DATE
JCircle the one that applies
Is parcel on sept' or public sel er2
Y / No
Will you be putting up a new sign cif any kind" If so; obtain proper
Sign permit,
Permit #
Y , t N /
Will `t-fi'ere be any new construction or renovations?
If so, obtain the proper 11ennit.
Permit #
'onip to com fete the folloWing�
_...
I Violations:
Y / N
If so, List:
Variance:
Y/N
If so, List:
Clearances:
.Reviewer to complete the following:
Square footage of Use: >4'
{,j'J i N
Permitted as: }
Under Section: /)1(j11 i''t
Supplementary regulation; section: l
I
Parking formula:
Required spaces:
[: N —
ItenIs to be verified in the field:
Inspector
;dotes:
Date:
I� Proffers:
!YN�
If so;rt.ist:
Ot-
Irs.- ..tst:
SDP's
`L , F�!ri'f— W I
Revised 11/I:2015 Page 3 of'3