HomeMy WebLinkAboutCLE201000066 Review Comments Zoning Clearance 2010-04-22Application for Zoning Clearance
CLE # �DlO —Z
Ozoning Clearance = $35
OFFICE USE ONLY
Checic # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # ' '7!9'1100 Staff:
PARCEL INFORMATION
�� ��
Tax Map and Parcel: Existing Zoning
Parcel Owner: 'FAIVT0 5 L Lc",
Parcel Address: q0 prv?V-C, yu City CNAK&0M >VJVState V4_ ZipZZ
(include suite or floor)
PRIMARY CONTACT 'DAn/ Ej� O�n�
A' V
Who should we call /write concerning this project?
Address: 5AMC State Zip
GCity
Office Phone: �I( 3�1 61 g517, a Cell # l G Z qZj / Fax # '917 Wo E -mail daft 1 e(- 'j 0 flda 1� V0 b'CD1'Yf
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name v1 New business
Business Name/Type: CrOWN M0TUk(AV_ iajPdNY Lri
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: 17AZ1441 i FOt 35 4F,tftVYM (`l'
of c,eDWN &M PLO - &07 4
A-r TftC %VTO rAIJ> Dj� '-1K 16 tvT - 5;a �7fiLh�
*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 best of my k ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
�tootthe
Signature `/ / I"/ Printed
APPROVAL INFORMATION
[ ] Approved as proposed [ tTApproved 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 s to complies with e s' e n s jf t�h}'�s to
Notes: 01 ��
Building Official Date is t
e<qj V
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
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there 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 public water?
If private well, provide 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 septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
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
��
�-C�
��
S
V
' —�
Y'
J
� � i
�� � � �
�_ � � � 3
>� /��j�� I� � �
— �/1/�' �C � `�
� �
� � �� O b
�.
�-�-
� � � � v ��,
l� �
� � _ Y