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HomeMy WebLinkAboutCLE201800184 Application 2018-09-05Application for Zoning Clearance CLE # PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # ('14 0/Xo Date: Receipt # Staff: ff- PARCEL INFORMATION Tax Map and Parcel: rat( (U l9 "d0 /C- D A Existing Zoning ,,, «orn,� o "cQa Parcel Owner: l� C C e—a Parcel Address: act City State !�� Zip a o (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address: 262 -7 �©pJ,l ,) 1L City � Z/ � State �A Zip r38 6 Office Phone: ( 5 777);tell # Fax # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: h-W PAT Previous Business on this siteT Describe the proposed business including use, number of employeesnumber of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: a C,51�'uo /to i �c,�u.2.,�-- , 3ye I•.i c I o c- �{y—i�i ��`-�� *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 the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature jw, Printed APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 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 oZ Zoning Official Date 3C 1 Other Official _ Date i.:ounty of Alpemarle department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 r>r- Revised 11/02/2015 Page 2 of 3 Intake to complete the following: Y / I Is use m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wil re 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 or public wa r? If private well, provide Health ent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that app ' Is parcel on septic or ubSsewe) Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the followin : Reviewer to complete the following: Square footage of Use: �� Yl / N q*rmitted as: �{ i Under Section: ,�• , Supplementary regulations section: Parking formula: 1 I �ca0 nit' Required spaces: Y tV Ite to be verified in the field: Inspector : Notes: Date: Viol ns: Y /.FW If solList: Proffers: Y/N If so, List: Z oI A G- G-� �,�.L`4 Variance: Y/N If so, List: SP's Y kN If so"List: Clearances: SDP's Sp to t q ° f V I Revised 11/1/2015 Page 3 of 3