HomeMy WebLinkAboutCLE201000031 Review Comments Zoning Clearance 2010-03-10CWI
Application for Zoning Clearance9�
CLE # 2° Q / d 3)
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
OFFICE USE ONLY
Zoning Clearance = $35
PLEA REVIEW ALL 3 SLEETS
Check # LI 43 Date: � L7.16
Receipt #.
Staff: FpUut
PARCEL INFORMATION —.3 .� r �
Tax Map and Parcel: Existing Zoning l`
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Parcel Owner: �yy� ",'Viet M c �i1Sa"►�e lQLS it
Parcel Address: a S 4 C t- `DCity OnQdb 1�, �(�( State VA Zip 22 to 1
(include suite or floor)
PRIMARY CONTACT
Who /write a
should we call concerning this project? 5'Ctr -Nn Ussd
Address: 3054 L City C," M k°,. State WA Zip
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Office Phone: dal) 2% OG�C ►U Cell # 24C! -957L Fax # 2 GGs 0600E -mail O CI IA �r _ (� nai l'
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: LC i--,7 � C! 1pc ,r'4!� o
Previous Business on this site_ k-_ P -L Jc C7 0.---, `
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: �_h �lS; Ct 1
1
*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.
Signature Printed S
AP ,ROVAL INFORMATION
[ 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:
Building Official- --- Date
Zoning Official Date 6 J
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 u °C n LI, HI or PDII' zoning?
Engineer's Report (CER) packet.
Y / N�
If so, give applicant a Certified
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 applies
Is parcel on private well o public water ?) P-611-
If private well, provide 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 septic or,public sewer ?�)
Y /&)
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wil t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followine:
Reviewer to complete the following:
Square footage of Use: -1-10 C)
N
P rmitted as:-Y + ��
Under Section:
Supplementary regulation section:
A
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector :
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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