HomeMy WebLinkAboutCLE200900111 Review Comments Zoning Clearance 2009-07-14Application for Zoning Clearance
CLE # �� - i / /
o-
Zoning Clearance = $35
OFFICE USE ONLY `
Check #5 h' Date:
-7
PLEAS REVIEW ALL 3 SHEETS
Receipt # S"S9 Staff: IL
PARCEL INFORMATION G� a - d 1- a - 2 °
Tax Map and Parcel: b 1 Existing Zoning
Parcel Owner: 6M 1 GEC 6 -e L A-� t� 3 `l — J Go -S7-00
V , ' Z29'�
Parcel Address: t 2 D � W 0 � T G ��' Ci ty a UZ2 — State Zip
(include suite or floor) S-el t t
PRIMARY CONTACT
Who should we call /write concerning this project? SU 6
Address City State Zip
Office Phone: L_) Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: E (S ► D a- 7 C O\J
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 percussion 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 Printed �2 CAtlLt�CL 6Z-
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, 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 Date f3 Cz
Zoning Official Date G
Other Official Date
01
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
��9 3
SAy- of -O-ZD
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /X�
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 public water?
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic r u lic sewer?
Y
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 # t—) U
ZoninLY to comiDlete the followin :
Reviewer to complete the following:
Square footage of Use: r) 12w
/N
_ ermitted as:i
Under Section:
Supplementary regulatigns section:
Parking formula: I / ! 15-b0
Required spaces:
Y/N J
Items to be verified in the field:
Inspector:
Mo ,i
VA
Date:
Viola ' s:
Y /
Ifs , ist:
Prof e
Y,/
If so List:
i
I
V ri ce:
Y
If so, List:
SP'
/N
If , ist:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3