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HomeMy WebLinkAboutCLE200900141 Review Comments Zoning Clearance 2009-11-20Application for Zoning Clearance CLE # /` / 2 = OFFICE USE NL �}�) �' Check # l Date: D 7V / v q Zoning Clearance $35 PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: ail PARCEL INFORMATION `7 Tax Map and Parcel: M , �i�} i L Existing Zoning/ / ,/ Parcel Owner: l�16 ✓ �0� / %`/� ,�� �• �� ` Vx ILJ Parcel Address: 176M &L�J & 1 1,--R1tZdZ Ci ty (t h� r�© �yi�� State V'* Zipzzy // ' (include suite or floor) PRIMARY CONTACT 'Td Who should we call /write concerning this project? a »L-- Q,, } Address ") 6GCCI� F—D -City/ %L' State `%i19- Zip 7292 Office Phone: Cell # Fax # 4AP"�- E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business (� Business Name /Type: %/VSLj�41tf6 � Etta rC%4L —' /. t L-1_1 tJ /nJC Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of information Me-15/1ca / ifo-, JS Q / -np—&) C vehicles, and any additional that you can provide: l';7qri F� *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 a c r to to the best of m ow�7l,edg I ha e read the conditions of approval, and I understand the�m�, and that I will abide by them. /e. Signature rte, 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 l Zoning Official t.._/ Date�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 / NN Square footage of Use: Is use in LI, HI or PDIP zoning? If so, give applicant a Certified � Engineer's Report (CER) packet. ' Y) / N , �y, (��+ /'� (--ppllermitted as: t �-t'�, t�1C• L°-1 Y Y� N ) Will ere be food preparation? Under Section: 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 Circle the one that applies Parking formula: Is parcel on private well ublic water? !� If private well, provide Hea ment form. Zoning review can not begin until we receive approval from Health Required spaces: i Dept. FAX DATE Y/N Circle the one that applies Item o be verified in the field: Is parcel on septic I c sewer Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # J/ N Will there be any new construction or renovations? If so, obtain the pro r Permit. Permit #-v, O Zoning to eomnlete the following: Inspector : Date: Notes: Viol bons: Y oy If so, ist: Proffer . Y / If so, t: Varc ce: Y/U If so, List: SP's: Y /1`G) If so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3 S G f e rn'url»r.r vn.l y � �i� � � � 208Cf eIx6N M elluuaV� 3N'li391s W, WE 10311HDhfV N0S2130NN BOB o� afE §q 8 ns�Xb @ $ k6g a k: e!;B? f°! a DIE �e Bg � ;CE° �s �9t gy{� ' y ".Vs5 5= g Z qygol le, 9b"61. o gil7 g Ed r vl�'?LIN63l101WN�'Utlf)tl IItlNN�lll. _.. _. 0.... � ommine 301330 HUN N831SV3 1f10wi INVN31 � E \v \ :� C D J L C L � I W J — U l �