HomeMy WebLinkAboutCLE201800011 Application 2018-01-19Application fo Zon'rg Clearance
°Y�t
CLE#
PLEASE REVIEW ALL 3 SHEETS
OFFICEU SE O t V
Check # (�VCC,i`C Date: 1 1,74 1
Receipt # T�Staff: `5
PARCEL INFORMATION tip 3 09
Tax Map and Parcel: ( Existing Zoning' }J�J
ttPafC,P
Parcel Owner: c,zrt�� �� , �en, tC' °,— fJ i 11 LrLrL_C_
Parcel Address: r,rc _ Dr_ .5>yJ,_ f City kenrlo-4e:5y, lI State yA_ Zip
(include suite or floor)
PRIMARY CONTACT /�
Who should we call/write concerning this project? ! � t V12.A%C-15r
Address : `; / + 1� L✓s`e� jDS 5j f-tc loq City � T Stlz l�� State VA Zip
Office Phone: ( )� - 94q� Cell #904-9t1-0a�tFax # E-mailJIA-r�^�al AAA (1CrP° G�tLv c
4.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
% /
Business Name/Type: %��, �� (rL'e (� r l�c �/1c'✓t'� GSa ! / i�P. �st�i t, �L7-t I
Previous Business on this site p0411 �� till 01-4 �D � yC S J �,�l�+c 1 C�,.Ti� - De
Describe the proposed business including use, number of emplovees, number of shifts, avflabie parking spaces, number of
vehicles, and any additional information that you can provide:% �G� iLF cirFt o C 5
(i rL �`i �ln:c F P_e X k'c s Cwr ) c r �+
cr vt plrc,-v ,,,
*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.
h'
a
1 hereby certify that I o or hav a owner's permission to use t space indicated on this application. I also certify that the information provided
is true and accurate to e best f y know] dge. I have read th onditions of approval, and I understand them, and that I will abide by them.
Signature Pnpted /4,t J L't '5C,bl
r K ,,1,5 Cprcg
t
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ J Denied
[ ],5°ckflow prevention device and/or current test data needed for thus site. Contact ACSA, 977-4511, xI 17.
[,?No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plats.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official i' Date
Zoning Official Date i/I SA $
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902; Voice: (434) 296-5832 Fax: (434) 9724126
Revised 1 1/02/2015 Page 2 of 3
G /v ,
Intake to complete the following:
Y /0
Is use to LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
Y /F
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 r�Dppame,,t
If private well, provide Healform.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or blic sewer
Y/N
ill you be putting up a new sign of any kind?
Sign permit.
Permit # &Lo 17
to complete the following:
footage of Use: L / 1 3 :
N l r
fitted as: �yERttnSSlUI^Gi) t�ffltQ,; t�Fnl1
1S
:r Section: L���I
Supplementary regulations section: 1
ILI CZJ
formula: I/175'e�(denfia) ctlnl L
spaces:
be verified in the field:
If so, obtain proper
Inspector Date:
Y /w
Will there be any new construction or renovations?
If so, obtain the, proper Permit.
Permit #
Zoning to complete the following:
otes:
i`,c,rr,l. OMrw, , 0il
Vio s:
Y tr N J
If so, st:
Proffers:
Y A` N
If sib, List:
Variance:
Y/N
If so, List:
jc117—
SP's:
Y!N
If so, List:
Ioa—
Clearances:
Y
I S S 3
Revised 11/1/2015 Page 3 of 3