HomeMy WebLinkAboutCLE201000044 Review Comments No Submittal Type Selected 2010-03-22Application for Zonin Clearance
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CLE # 20 10
Zoning Clearance = $35
OFFICE US ONLY
Check # % Date: J�- -�o
PLEASE REVIEW ALL 3 SLEETS
Receipt # Staff::V.,kl
PARCEL INFORMATION
Tax Map and Parcel: 6U —.n Q °c7 d —6oV66 Existing Zoning
f
der
Parcel Owner: �1 an (.. er (i n @-e 14oryI G S
Parcel Address: 11V� % _/� Arai /City (6r (o --Sul Ile State V Zip 22?0 I
(include suite or floor)
PRIMARY CONTACT
Fe a IVez-
Who should we call /write concerning this project? 6
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Address: /TZ1 _ce_enitr)OlE' Trai / City Cbar lo11sUlAe State ZipZ290 �
Office Phone: //( 39) 2 c13 — P?Zg Cell # 2 LIF-32 G 7 Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use of name New business
lChange
Business Name/Type: f�
Previous Business on this site
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: �ld; rC•u -/S/ /Aq i r- co16Y7,rr 76✓o e°vn loveer,
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature i Printed <°- / a w e Z_
/`. / %C
APPROVAL 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 :Z�
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
owl
Intake to complete the following:
Reviewer to complete the following:
Y N
<5h)--N d
Square footage of Use:
IsZ LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Qrmifted N b 1'1
as:
Va ian e:
Y N
If s List•
SP' .
Y/N
If st:
W' the be food preparation?
Under Section: �- I
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulati ns section:
9
Dept. FAX DATE
V�
Clearances:
Circle the one that applies
Parking formula:
Is parcel on private well or u c w ter?
If private well, provide Heal ment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that app ' s
Items to be verified in the field:
Is parcel on septic or ublic se er?
Y/N
Will you be putting up a new . of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Dat
Y / N
Notes:
Will there be any new constructi n or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlete the following:
Viola ions:
If
Y�Pst:
Proffers:
Y/K
If so, 1st:
Va ian e:
Y N
If s List•
SP' .
Y/N
If st:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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