HomeMy WebLinkAboutCLE201000030 Review Comments Zoning Clearance 2010-03-10Application for Zoning Clearance
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Zoning Clearance = $35
OFFICE US ONLY
Check # ILIA Date: �` U
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: 6/ .,Ul, l�!
PARCEL INFORMATION j n
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Tax Map and Parcel: t'j Existing Zoning
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Lave Saps,
Parcel Owner: rd(esj -5
Parcel Address: ) 10 imbGrwood �& IV61 - City State VA i Zip "`' � 11
(include suite or floor) '94e lol
PRIMARY CONTACT
Who should we call /write concerning this project? 1
Address: 1'77b`f .,Y,G,«- c,���,4.i�UYQ. City State
Office Phone: oc)o? Cell # g?,d. Oka- Fax # ,/„ /n 5 I - E -mail;
701V
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name -New business
Business Name /Type: :g,2 r-agl( AA7N n , `&a i'�tnL J
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and an additional information that you can provide:'{, 9 Ql bye94 , - 12MI111 Q
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*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 info miation 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
AP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow 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 _ s
Zoning Official Date 3 ((J tb
Other Official Date
1 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
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Intake to complete the following:
Reviewer to complete the
(N�
Lfollowing:
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Square footage of Use: '''7
IY s us�r�LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
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Vari i e:
Y /
If s st:
ermitted as: 0-!4
`
Y / t
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Will re be food preparation?
Under Section: o1
If so, give applicant a Health Department fonn.
Zoning review can -not begin until we receive approval-from Health
- Supplementary regulations s
ction:
Dept. FAX DATE
✓ Z
GL
Circle the one that applies
Parking formula: �n �
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Is parcel on private well or E��Orm.
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If private well, provide Healt
Zoning review can not begin until we receive approval from Health
Required spaces��, % _u
C.B�� -C
Dept. FAX DATE
Y/N
Circle the one that a • s
Items to be verified in the field:
Is parcel on septic •public se
/
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit # 9L) 10 - ol •7 0 Inspector : Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7oning, to complete the following,:
Viola o s:
Y /lam
If so, List:
Proffers:
Y
Ifs rst:
Vari i e:
Y /
If s st:
SP's:
Y /
If so, ist:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
MAR-03-2010 I6:Q9
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