HomeMy WebLinkAboutCLE201000071 Review Comments Zoning Clearance 2010-04-30Applicati ®n for Zoning Clearance
CLE #t1 () -qj
❑ Zoning Clearance = $35
OFFICE % O LY
Check # S Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION aa
Tax Map and Parcel: • ol� Existing Zoning
Parcel Owner: ID �Llo �M4
Parcel Address:��0 pu.. 0 , City ' . State Zil kw
���� 1
(include suite or floor)
PRIMARY CONTACT -. /
Who should we call /write concerning this project? 3 ` C 7,e �`-
Address del) l��C�� / U` i City (1 °��/%< State Zip
Office Phone: 60Cell # Fax # E- mail, 59qCECC tkC4I6�
t-C�Ci�S -ri, C0;777
APPLICANT INFORMATION
Check any that apply: Change of ownership of use Change of name New business
�Change
Business Name /Type: Ut��f
Previous Business on this site
Describe the proposed business including use, number of employees, number of shJifts,s , available parking spaces, number of
vehicles, and any additional infQrma 'onth /at you can provide: (�(/�J ,�1�� E'" //a_ C� G ids
*This Clearance will only 156 valid on the parcel for which it is fipprov&d. If you change, intensify or move the use to anew location, a new Zoning
Clearance will be required.
I here . ertify that I n or iav re wner's permission to use the space indicated on this application. I also certify that the information provided
is true and ac irate e b t my nowledge. I have read the conditions of approval, and /I,understand them, and that I will abide by them.
Signature Printed T> �
AP OVAL INFORMATION
[1/] 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 determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official c Date (t;>
Zoning Official Date
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:
Reviewer to complete the following:
QY / N
ise ii LI, M or PDIP zoning? If so, give applicant a Certified
Square footage of Use: , v
Engineer'�"Report (CER) packet.
Y /ptiere
Will be food preparation?
Y / N
ermitted as:
Under Section:
If so, give applicant a Health Department fonn.
Zoning review can not begin until we receive approval fiom Health
Supplementary regulations sec 'on: .
Dept. FAX DATE
Va ance:
Y A'N j
If so, List:
Circle the one that applies
Parking fonnula:
Is parcel on private well ublic Ovate ?
Required spaces:
If private well, provide ea —r ment fonn.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Y/N
Clearances:
Circle the one that applies
Items to be verified in the field:
Is parcel on septic o ublic sewe A
Y/N
Will you be putting up a new sign of any 1drnd? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
I, /
Notes:
Wi] ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to emmnlPtP the fnllnwinff-
Violations:
Y/
If soFs :
Proffers:
Y //j
If so, ist:
Va ance:
Y A'N j
If so, List:
S s:
/
I ,List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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