HomeMy WebLinkAboutCLE201000001 Review Comments Zoning Clearance 2010-01-12NQrn� � Oni�
Application for Zoning Clearance
CLE # �J0 '" �
�RGIN�P
❑ Zoning Clearance = $35
OFFICE U O LY
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff- -
PARCEL INFORMATION / ��//1 � c n
i,31
Tax Map and Parcel: (AM �� / - W- I I Existing Zoning D
Parcel Owner:
Parcel Address: 'CvOc� G (�!(I 1q J+_ City ck4y, S1 j� /�� State Vim- Zip )396
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? t? �a; l^ DL y�
Address: �1 77/ It c v!' 3^�S �oa�r'f� Y' City 4440--S di li- - State lid Zip 23,9 D
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Office Phone: U Cell # Fax # E -mail &,;o ynna.J a Wi-na d. c ,-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: f),i^ j cg _. /Q C_
Previous Business on this
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 pennission 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 abide by them.
/will
Printed ft l 0 y4 )', J �/0 52010
Signature M-f
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacl&ow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] 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 (/ SI 1
Zoning Official Date S/� 9'
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, 10/13/09 Page 2 of 3
Intake to complete the following:
Is/
Is use n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 app lees' ---
s wa
Is parcel on private well or. .;t iter.
If private well, provide H54WIIJ2epaitment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies -
Is parcel on septic or p lie sewer
Y 6)
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will e be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin¢ to complete the following:
Reviewer to complete the following:
Square footage of Use:
"Y /N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so, st:
Proff s:
Y/
If so, ist:
Variance:
Y/�
If so, ist:
SP's:
Y/Cl�
If so, ist:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3