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HomeMy WebLinkAboutCLE201800026 Application 2018-02-05V Application for Zoning Clearance CLE #;t L/O()oP ,. PLEASE REVIENV ALL 3 SHEETS OFFICE t E ONLY Check #fy Date:' Receipt 472w3K Staff: PARCEL INFORM TI ' S' %'r �M Tax Map and Parcel: v V Existing Zoning l�Ul1t t Parcel Owner: C,4�ttdel /b r Parcel Address 3 ©��^ � �VI � [c)v'' City V State /"f Zip (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this roject? i t t �� Address : J 1 (t 1 r�S r City G e State f% Zi] Office Phone: ( ,N/ "Q 5dll 4 �a, Fax # E-m4.t- ♦1 1VV! APPLICANT INFORMATION Check any that apply: Change of ownership Change use/Change of name New business / /-off Business Name/Type: �t /�,�� �`� L lZL(I% Previous Business on this site 1✓'V���(t �, pro Describe the proposed business including use, number of employees tLturliber shifts, mailable parking spaces, nu►nber of vehicles, and any additional information that. can provide: %}� ®SJ J��`l/6 � S t! I17 / "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 I own or have th owner's pennission to use the space indicated on this application. I also certify that the information provided is true and accurate to the 1 1 of m know] ge. ave cad the conditions of approval, and 1 w16�nvand them; and that 1 will bi e by them. C l�Ki Signature �� wv � W Printed NC/ APP,VeOVAL INFORMATION [ pproved as proposed [ ] Approved with conditions ( ] Denied [ ] ckflow prevention device and/or cun-ent test data needed for this site. Contact ACSA, 9 77-451 1, x 117. [ 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 Zoning Official LV Date Other Official Date f_ ounty of Albemarle Department of Community Development 401 Rlclntire Road Charlottesville. VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 CI� 11 Ft"ised 11 02 201" paic 2 of Intake to complete the following: }' ( ) Is u m Ll, H1 or PD1P zoning? ]f so; give applicant a Certified Engineer's Report (CER) packet. Y/N 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 1well o ublic water' If private well, provide Hea partment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appli Is parcel on septic public sewer? Y/N Will you be putting up a new sign of any kind? if so; obtain proper Sign pennit. Permit## Wwlh YP�UIIt Scpq Y / N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit #t Zoning to cons 0'io ors: Y If so; ust: the followinu: Reviewer to complete the following: Square footage of Use: S YIN 11 Permitted as: bt U 1 �S$) Uy►�,p Under Section: Supplementary regulations section: Parking formula: 1 tZOO ref Required spaces: t L Y / N Ite . be verified in the field: Inspector : Date: Notes: Proff Y / N If so, ist: Vari ce: SP's: If / .N I Ifs ist: fs psi: Clearances: CSDP's l.E2�lrJ.. 21c f3a� - G F��-n sl i Revised 1 1 1 2015 Page ? of 3