HomeMy WebLinkAboutCLE201000037 Review Comments Zoning Clearance 2010-03-09Application for ZoRi Clearance
CLE # )0/0 —6—r
❑ Zoning Clearance = $35
OFFICE USE ONLY
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # D Staff:
PARCEL-INFORMATION
Tax Map and Parcel: - Existing Zoning PDM
Parcel Owner: 64
, Q ` ` )
Parcel Address: �� / l t City �,'l1\)' State V Zip
(include suite ok floor)
PRIMARY CONTACTC 'e-
Who should we call/write concerning this
project. d �%�
Address: �f�/Js!L2.�Y' , J'/ City 1C,5`G !la'('Y State Zip
Office Phone: '2�� O JAL ell # �� Fax #49�5 `" ,M/7 E- mail -jft !�#/P Vii' G9' fit,`
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:.�� % 60
v
Previous Business on this site 3�✓ 4 tt�S
Describe the proposed business including use, number of employees, iiijmber of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: &legA / Nr \� /�d` IL? - ,4,M -0V- I d E=�^�A
We�7 Ghn — /0/ -�/P� y
*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 -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 accur to the best oar lodge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Sigrratr / Printed I) " / /t' S�4' C '� e
APPROVAL INFORMAJWN
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 17.
[ ] 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 i co
Zoning Official Date is
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
C&h
%OeCj_
Intake to complete the following:
Y G
Is use in LI, HI or PDIP zoning? If so, give applicant a Certifie d
Engineer's Report (CER) packet.
Y/N
ill there be food preparation?
If so, give applicant a Health Department form.
Reviewer to complete the following:
r
Square footage of Use: / �j2 ` /
(Y)/ N
Permitted as: '0 6LI-f y1 u,
Under Section: CZ) oZ
-Zoning review-can-not-begin until= -we= receive approval from= Health - Supplementary regulatio s- section: - - -
Dept. FAX DATE "/t a-
Circle the one that applies Parking formal `
lic Ov
Is parcel on private well or p[f ate �r-
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health Required spaces: fu,�
Dept. FAX DATE
Y/N
Circle the one that applie Items to be verified in the field:
Is parcel on septic o �ublic_sewer)
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pe -(� Inspector : Date:
Permit it tMb--Qa1 J
Y/N
Will there be any new construction or renovations?
If so, obta �MrPermit # " )
7oninu to comnlete the follnwinu:
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