HomeMy WebLinkAboutCLE200900090 Review Comments Zoning Clearance 2010-05-19- Application for Zoning Clearance
CLE # '- Q
`IRGIN�P
Zoning Clearance = $35
OFFICE USE ON
Check # v��c� Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # q Staff: r EGG / %P
PARCEL INFORMATION
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Tax Map and Parcel: ( -r�� -�-- �Q?j(�� __ Existing Zoning -- - -/- �— - --
Parcel Owner:t1�
Parcel Address: � 5 �Ccc\ LC_C`_, City � \\C State y rA, Zipga
(include suite or floor)
PRIMARY CONTACT
*should /write \GAGS,
Who we call concerning this project ?�� —Cj(
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Address • lam. �X City R -� u�1 pct State V Va Zip:;�,�LA
Office Phone: Cell # Fax # l6-01 S E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Ma e_6 C — \,N
Previous 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: �;
*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 accurat° to (t e best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPR AL INFORMATION
,[ 4 Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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 - t
�I:
Zoning Official l),-2; _I Date ���� %
1.1 r
t`
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
Intake to complete the following: Reviewer to complete the following:
Y / N - - - - - - - -- -- -- -- - -- - - - -- - Square- footage of-Use:-
-- -- -
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N
6--)
ermitted as:
Y /O
Will there be food preparation? Under Section: a %
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations Section:
__
Dept.. FAX DATE _ -_ hl q _. _. _
Circle the one that applies
Is parcel on private well ol<ublic water?
Parking formula: /
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. - FAX DATE - - -- - - -- - - - - -
- - - -- -- -- - -
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y 0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector: L4 50- C— Date:
Y N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit* A
Zoning to complete the following:
Violations:
Y/
If mist:
Prof rs:
Y/
If so, List:
Vaf' ice:
Y
If s st:
S s:
Y
If so, ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3
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