HomeMy WebLinkAboutCLE201700277 Application 2017-12-15Application for Zoning Clearance
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OFFICE US ONLY
PLEASE REVIENV ALL 3 SHEETS
Check # Date: hAl
Receipt # Staff:
PARCEL INFORMATION J /
Tax Asap and Parcel; % ?d0 d --NOKO Existing Zoning y 414 � ge
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VParcel Owner: c� OCy /��� ► �C
Parcel Address: %?q® gr4(,va-2 fCity R/"�Odvef (/l/�P State [/ i0� Zip 22��
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(include suite or floor)
PRIMARY CONTACT
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Who should we call/write concerning this protect? /- `P GI'1 (G�✓�
Address : 7 `Z City LJ/l �I/'/Up�f (//�State �� Zip
Office Phone: (�%) �rJ Cell # Fax # E-mail����5�iC6v"t�?�JMR��
APPLICANT INFORMATION
Check any that apply: Change of ownership Changed of use of name New business
/Change
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Business Name/Type:!'t� �j�Gt �c`►�f"/milrfir�� /'�(/l/►i^�G)1'�
Previous Business DaL�-' l f;zze-
on this site l
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
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vehicles, and any additional information that you can provide: la�i,yiic�n, vviG(�i��,B,L�P� /YIGt/IC!
101t� �Gl",�.P.at'/b 4taGt! �r®rr�y ol't`��Gtop�e��,FJ
'This Clearance will only be valid on the parcel for which it is approved. if you change, intensify or rnove the use to a new location, a new Zoning
Clearance will be required.
l hereby certify that I own or have the owner's pennission to use the space indicated on this application. 1 also ceilify that the information provided
is true and accurate to the best of my kn ,ledge. 1 have read the conditions of approval, and 1 understand and that I will abide by them.
them,
Signature Printed � O�9an __ SGJCGn.7
AP OVAL FORMATION
['I,f Approved as proposed [ ] Approved �vith conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x 117.
[ 1, o 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 % Vz do
Zoning Official Date 2- 14 1 -
Other Official Date
CounINT of Albemarle Department of Community Development
401 Nicindre Road Charlottesville, VA 2242 Voice: (434) 296-5832 Fax: (434) 972-4126
d11-11
Re %i,ed l 1 02 201 � Pat,,e 2 of
0
Intake to complete the following:
Y/N
Is use in Ll. H1 or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Wil there be food preparation?
If so, give applicant a Health Department fonn.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on private Zel or public water?
If private well, provide form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic o public sewer?
Y / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit ## Vyfvld lewle Sep -"Ve
Y / N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # W RJA A—Aki-ili e sepgr-4e fie t rn�l
Zonin
Reviewer to complete the following:
Square footage of Use: 0 f f
Y/N
ennittedas: n COlrnmp(ejq� vSC
Under Section:
Supplementary regulations section:
Parking formula: LA i I ZG6
hP+
Required spaces: %
Y/1-1
f
Ile be verified in the field:
Inspector: Date:
Notes:
l.'l?ills page 3 ��1