HomeMy WebLinkAboutCLE201000055 Review Comments Zoning Clearance 2010-03-31Application for onin Clearance
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CLE # J
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Zoning Clearance = $35
OFFICE USE ONLY
Check # 3- Date:
-7
PLEASt REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 56 F d ` 1 �-! ad 6&R-2 Existing Zoning_ `j jQ kf
_
Parcel Owner: ,' Q Lk1-)V,-1, Cr h1 50�C -�l �Cl:T
t- ��'�
Parcel Address. Fou r Lea, C t, e ;0 City char lb State
(include suite or floor)
PRIMARY CONTACT
y�
Who should we call /write concerning this project? 5" 15Q- r"-%CL r
Address :325 Y0"1- Uarve.. S t,1,t 40 City Ch arkh- so) State 1 Zip Q
Office Phone: N -f d Cell # Fax # E -mail & kg,t'Y and L515.
APPLICANT INFORMATION
Check any that apply: Change of ownership, Change of use Change of name New business
Business Name/Type: A. w� M . q`c4 T i nn9..i COLA05din'4j OI h e
NJ
Previous Business on this site m tq,,A ,l 1 �,e_ci QC1 it 1
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: no e'v" P l O u e t s t S er Ut C e s b u
Ci too �+ Iyl P,v� iL11 t G1
*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 accur a to
dge. I ha ve read the conditions of approval, and I understannnd them, and that I will abide by them.Signature
�olmy
, Printed NO E / /T ,
APPR6VAL 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 f.•�: -k Date f a d
Zoning Official Date( O
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
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I
Intake to complete the following:
Is us LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will ere 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 or
If private well, provide Hea
Zoning review can not begi
Dept. FAX DATE
Circle the one that ap
Is parcel on septic or
Y/N
Will you be putting
Sign permit.
Permit #
Y/N
Will there be any
If so, obtain the p
Permit #
Reviewer to complete the following:
Square footage of Use: 7-3`7
Permitted as: 1) ► A"' dP GC..
Under Section: d6 • .2- 1
Supplementary regulations section:
M_i
Parking formula: ' IV 0
l epartment form.
until we receive approval from Health Required spaces:
a new sign of any kind? If so, obtain proper
construction or renovations?
Permit.
Zoning to complete the following:
Y/N
Items to be verified in the field:
Violations:
Y /�I
If soiList:
roffers:
/N
so, Li t:
Varrj
If sb;'List:
(SSP's:
I so List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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