HomeMy WebLinkAboutCLE201000059 Review Comments Zoning Clearance 2010-04-08Tom/
Application for Zoning Clearance
CLE # SIG 5-1
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Zoning Clearance = $35
OFFICE USE LY
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff. ---j
PARCEL INFORMATION h.
Tax Map and Parcel: 0`l44 6 a yO ` D0 '" / � � � � Existing Zoning L
Parcel Owner: / fQ��`��
Parcel Address: �IL/ �r / I,��� qty ,� State V%J '' Zip
(include suite or floor)
PRIMARY CONTACT
Who should we / call/write %concerning this project? /t / / J
Address: &a � l.0 / G � %i�! (�f City V (/ ��( K State �/✓ Zip
Office Phone: 7 —* Cell #one: Cell # 5V • L- L C Fax # E -mail af - EY��
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business)
Business Name /Type:
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:
*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 pernussion to use the space indicated on this application. I also certify that the information provided
is true and accurate tg the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Suture -`' ; �.� i�•r�w� --l�� Printed C—Z 6-111 112 / Ld
APPROVAL INFORMATION
[]`Approved as proposed [ ] Approved with conditions [ ] Denied
' ] Bacl&ow 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 detennination 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 :zz%z d
Other Official PA Kkz -���q Date
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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 f"ol)lowlIing:
Y (I
Square footage of Use: �i U Q.
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Y)/ N //
Permitted as: A)A4 cam/ �I o 41'Ic
Wi lere be food preparation?
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
Circle the one that applies
Is parcel on private well or uPepartmelint e?
Parking formula:
If private well, provide Hea form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Required spaces: j
/
Y/0
Items to be verified in the field:
Circle the one that applies
Is parcel on septic or ublic sewer.
Y / 4�/
Will you be putting up a new sign of any ]find? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y /(—�)
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninv to emmn1PttP the fnllnwino:
Violations:
h /N
` f so List:
Proffers:
Y/(!D
If so List:
Variance:
Y /A
If so" List:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3