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HomeMy WebLinkAboutCLE201000024 Review Comments Zoning Clearance 2010-03-03Application for Zoning Clearance A`' CLE # �(J /0 01/ A �'jliGltnP Zoning Clearance = $35 OFFICE USE ONLY / Check # a0 Z Date: ' ! `, � 0 PLEA REVIEW ALL 3 SHEETS S + 7 Receipt # `7 / 4 Staff: PARCEL INFORMATION '" QrJ Tax Map and Parcel: Existing Zoning_ t? . Parcel Owner: fywl �-��ro ���'�ic�►tJwa� /�( 1 f 2 Cat City li ` I" State �/ k Zip Parcel Address: (include suite or fl4 or) PRIMARY CONTACT Who should we call/write concerning this project? Address: -�VS_© '�NC%r-S'c ,^' �^'' City � r yo & State Zip �oZ Office Phone: y(3 ) 9 f�-07 a Cell # M/- ff 7-d07 Fax # E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: Si- G C R4Tit, L Previous Business on this site MO 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: 0- w / //h S'avo'e .r 3--l-5- / -.5'17 < P4 *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 permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowled . I have read the conditions of approval, and II understand them, and that I will abide by them. Signature Printed IPPROVAL INFORMATION ['J Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow 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: F-Ekw( �o 3z1o'10 for Building Official I Date I �� �� Zoning Official Date 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: Y/ Is use LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/ Will e 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 or p�ter? If private well, provide Heap l epartment form. Zoning review can not begiii until we receive approval from Health Dept. FAX DATE Circle the one that applie Is parcel on septic or p he wer? Reviewer to complete the following: Square footage of Use: Roo N ff fitted as:GU 4 Under Section: r,26,,--1 Supplementary regulaps�section: YL, (( Parking formgla: Required spaces: k'r S Y/N 9 1 Items to be verified in the field: Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Zi Inspector Permit # )/ N Notes: ill there jbny new construction or renovations? so, obtaePoper Permit. :rmit # �''( C„ Zoning to complete the following: Date: Violations: Y/g If so',�I,ist: Prof rs: /Op If so, List: Variance: Y/ If so, ist: SP's: Y/I j Ifs ,L'i`st: Clearances: SDP's Revised 04/28/08, 10/13/09 Page 3 of 3 i I -Z cif r7- J6 I -Z cif