HomeMy WebLinkAboutCLE200900203 Review Comments Zoning Clearance 2009-11-24Ap lication for Zonin Clearance_
CLE #� �6TS
7
��R[•,INt�'
WZoning
OFFICE USE ONLY
�
Date: 11,2010?
Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt# 7 7J o Staff:
PARCEL INFO ON
di)
Tax Map and Parcel: Aq M Existing Zoning
Parcel Owner:
v
Parcel Address:— Cit State V f I • Zip
,o
(include suite or floor)
PRIMARY CONTACT ��fJ n,j �I �y
A IY 4 C LO '
Who should we call /write concerning this project? f�' I
Address : City( .State M t Zip z
Office Phone: �W CI (' ` &I114 Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: /1/ il(N( S. 10-099le hhS , Pc : 0IZ 10_b6M-E/0 -S DFFfGr-
Previous Business on this site ya (? v T W go \/F_ : N /� 1►� C� [.o�J
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: t%eTHa 'bp /JTI G n FF ICi' 02 ► Ho_i�h1TIS
-
iMF_jnA0fN 6,PF V "Z— AID 4L<1&NEt) PA2kiA16
*This Clearance will only be valid on the parcel f 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 or ha h er' ennission to use the s ace indicated on this application. I also certify that the information provided
is true and accurate e t e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
N
APP AL INFORMATION
[ App ved as proposed [ ] Approved with conditions [ ]Denied
[ 113a ow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
an.
siYtes:
[ his site complies with the site plan as of this date.
C/
N (')
B uilding Official Date ( `.3A Q C _
Zoning Official Date Z I
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
0
Intake to complete the following:
Y/0
Is us in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /1�1f
Wil ere 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 ublic water?
If private well, provide Heat epat ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o ublic sewer?
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, obt ' t er J%q
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: C)- � L y
/N
:-miffed as: Q T
Under Section: A3, )-,,v I
Supplementary regulations � e tion:
Parking formula: 1 /)-0 b n„
Required spaces: r C-)
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
�, o •wvl u`1 A�-
Viol 'ons:
Y/
so ist:
Proffers:
Y/L
If
If so' list:
Var ce:
YIf so/ , ist:
S s.
/
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3
� 4 0
V
1 N�
1V'a�'
'n �� Sq p T
F PACE-
L°°IV,
�LA N Lc
i A