HomeMy WebLinkAboutCLE201000026 Review Comments Zoning Clearance 2010-08-13PAI
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Application for Zoning Clearance
CLE # X2010 �-- 4
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OF FICE USE 0 LY 0 %�,/U
Check # Z, � Date:
Zoning Clearance = $35
PLEA63fC+ REVIEW ALL 3 SHEETS
Receipt # ]'7 �l Staff: C9 IdU 11
PARCEUINFORMATION
Tax Map and Parcel: 0(g� l o o — o D -- m - Id- ;M Existing Zoning
Parcel Owner : eln j�.,j v I- 1'�SbG (� 'Z-S L . >94J1 --e-�(
Parcel Address: I.A City C1hA1)r7k44ir>VN&te V Zip z7ff q
(include suite or floor)
PRIMARY CONTACT 1
D M
Who should we call /write concerning this project? cz J -Q.
Address: 9 S Z n o0 ST, 5 E, Sv -4 3 00City ofJQt l <S v tj lz State V O0. Zipag.1 02
Office Phone: -6 et b I -�k 1-7 0 Cell # q (9 1 ' ;L2ta X Fax # 1_7+ I GQ 8 E -mail t`_b_av e -ly) qb a (qt , C a ►r
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
vehicles, and any additional information that you can provide: 1' by 5 < < a 17 K k,,, Q.a U kme ko,4 t t -3
Qxtsli^ bulinirl
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Printed D t d m t r'C�'-c
Signature C 1 O� V a v
APP OVAL 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 _,,Q, - �J���. Date Z, C (C'
�U
Zoning Official Date �,3//
U
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
Pl - 110
1
Intake to complete the following:
Y /0'Is u 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.
Dept. FAX DATE
Circle the one that applies
Is parcel on private well ublie water
If private well, provide Healt i epart neat form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that
Is parcel on septic o public sewer?
Y, N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YEN
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #�/
;L .2, 3 G A r-v
0) -1.,/iD
7.nnina to emmniptP tba fnllnwinv-
Reviewer to complete the following:
Square footage of Use:
Qr/M�tted as: ✓Ad 6�C>Le.,
Under Section: �S 2 %� CO
Parking formula:
Required spaces:
Y /N0
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
<0/ N
If so, List: n
Proffers:
Y //NJ
If Gist:
--Variance:
NO
Y N
If so List:
SP's:
If so List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3