HomeMy WebLinkAboutCLE201000045 Review Comments Zoning Clearance 2010-03-28A pp lication for Zoning Clearance
0
Clearance = $35
OFFICE USE ONLY
Check # Date:
1�j � Staff: �)
PLEASZoning
REVIEW ALL 3 SHEETS
Receipt #
PARCEL INFORMATION _
Tax Map and Parcel: 0 3 Rno — W — 06 - (-YJ9C 0 Existing Zoning
Parcel Owner: (1(- U.i-C1'<<T1 _(Qn lam) t p
/
Parcel Address: 69 0 ( U i e+ k_(''S f-t"1 City O'�rto ���State V Zip ac) I
(include suite or floor)
PRIMARY CONTACT '' oo
hnnc) �EL&-
Who should we call/write concerning this project? =�
Address : I C" �Ck k e td R City bC.l.( to &v i LLe- State V Jar Zip a a-q
Office Phone: 6�1 S1 I - [ LX': O Cell # Fax # E -mail OA P_Lc S @ Csy
APPLICANT INFORMATION
Check any that apply: Chanige of ownership Change of use Change of name New business
Business Name /Type: \ l(+U0.l 1-
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: l tS AOL -e50j e- Svc'r _&e C- C: I cc, -
�1� Prri�Io�`i c�s - no y �S-t i?Stn c sRac'.0- Cc 4,6-ts 10 r1
*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 (l, _ . ( EAd 5 Printed 1'v( n1 e__ �-t ei C�
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
�, Date 3
Zoning Official (�
Other Official i 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
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Intake to complete the following:
Reviewer to complete the following:
Y N
�se i LI, HI or PDIP zoning? If so, give applicant a Certified
Enginee eport (CER) packet.
Square footage of Use:
Y / N
Y 1
Wil /fifer e be food preparation?
Permitted as:
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
SP's:
Y/N
If so, List:
Circle the one that applies
Parking formula:
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7,nninu to emmnlete the following:
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