HomeMy WebLinkAboutCLE201000017 Review Comments Zoning Clearance 2010-08-131" 90 rott,
Application for Zoning Clearance
CLE # okj. j q
�lRdN�*
F1 Zoning Zoning Clearance = $35
OFFICE ONLY !l
Check # Date; V
PLEASE REVIEW ALL -3 SHEETS
Receipt #_ Staff- __
PA.ItCEL`MORtVfA'Z'rON::::, `T�. _: • _.
Tax Map and Parcel; Existing Zonhrg�
pit-eel owner:
State
Parcel Address: City _Zlp�
(include suite or floor)
PRUY ARY CONTACT ''���-�}
Who should Nye call /write concerning this project? __ VO 1E I I A
Address: I � ' ~ i City State �—t Zip
Office Phone:o -IibCelt #�
(/
APPLICANT INFORM ZION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type;
4,WU P !�C 6CLC4-1
i
Previous $usiness oil this site [,G7 //1-: Gi kje2 " L-U-C�b
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: b Ct/i C 7
*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, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the spaceindicated'on this application. I also certify that the infonnationprovided
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 s Q, .?TA/ L Printed f za Wm
APPROVAL INFORMATION
as proposed [ j Approved with conditions [ j Denied
✓[/)'Approved
[ ] Backtiow 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 )-1 Y to
Zoning Official Date
Other Official Date 0`61 Q /2 c)1
t.:ourrty 01 Ataemarte.ueparmieruor Uommunrty.vave,opUieuL
401 McIntire Road Charlottesville, VA 22902 Voice: (934) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08,10/13/09 Page 2 of 3
Intake to complete the. fallatviug:. , Revietiver ta. cample a the fallowing: -
Y / Square footage of Use: -
'Is use iii LI, HI or PDIP zoniieg? If so, give applicant a Certified '
Engineer's Report (CER) packet.
Permitted as: eAt
Q1N
ill there be food preparation? Under Section:
If so, give applicant a Health Department form. -
- 'Zoning >rewe�V- can - not= begitnintii we- receive - approval -from= Health- = t�pplementar -y- regulations section, - -•- —_ -- -- _
.Dept. FAX DATE,
Circle the one that applies Parking formula: ')7
Is parcel on private well o )ublic rater
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept, TAX DATE
Y/
Circle the one that applies IterfiKo be verified in the fie : t
Is parcel on septic or ublie s were c�
Y/N
Will you be puffing up a new sign of any kind? If so, obtain proper -_ - --
Sign permit.
Per/m'i #
itt
YllN}
Will t rere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
rfnt.irin 4n nnm lafa fin fnlln�tinn•
Inspector
Notes:
Date:
Violations:
/N
f so, List: � / �
Protf, s:
Y/
If so, st:
o�
Variance:
Y /&
If so, List:
Y
SP'Rist:
If s
Clearances:
SDP's
i
- - Revised 04/28/08, 10/13/09 Page 3 of 3