HomeMy WebLinkAboutCLE201000072 Review Comments No Submittal Type Selected 2010-05-03Application for Zoning Clearance
CLE # , f did - e) 74
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # /l/a Date: � /G�/ D
Receipt # Staff:
4r,4 Z
PARCEL INFORMATION
Tax Map and Parcel: U✓'` .� ° D D - D D — O d / d d Existing Zoning '049 /% r,
Parcel Owner: o wli-p-c I &oz-, e��
Parcel Address: :�z5 rVf Lf /0'/'( City ar6 State 10 Zip °d *3
(include suite or floor)
PRIMARY CONTACT _ l /
Who should we call /write concerning this project? /v 1 oh okAer
Address: 3� P/J f _/ "•t�o'�eif City k�� /�St�r�P State 10 Zip 1�
Office Phone: U Cell #` ` 25.7 -f Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _New business
Business Name /Type: T' L�5�: �g t�f7118J
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available arking. spaces, number /of_
vehicles, and any additional information that you can provide: %i�uQ�dJCtr� -��m�' ` -57 %�
*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 have the wner's permission to use the space indicated on this application. I also certify that the information provided
is true and acc to_416 best of i owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
ff
Signature Printed
APPPRR� INFORMATION
pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow 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 L .& ('-
Zoning Official Date ko
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
i
I
Circle the one that ap ies
Is parcel on septic o public sewer
Y
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
Y /
Will sere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7,nninu to cmmnlete the fnllowinu:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violaf s:
Y/
If s ist:
Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use: Y-00 �9
Is use use in LI, HI or PDIP zoning? If so, give applicant a Certified
Varianc :
If so, List:
Engineer's Report (CER) packet.
Y / N A �.
Y /
Will there he food preparation?
rmitted as:
Under Section: � �r ✓ d
If so, give applicant a Health Department form.
Clearances:
SDP's
Zoning review can not begin until we receive approval from Health
Supplement a}�y regulations section: -
Dept. FAX DATE
V
Circle the one that applies �'�
Is parcel on private well ou ublic Ovate
Parking formula: / b O _ n_ l
1 ( (�
Required spaces:
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
J
Circle the one that ap ies
Is parcel on septic o public sewer
Y
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
Y /
Will sere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7,nninu to cmmnlete the fnllowinu:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violaf s:
Y/
If s ist:
r ffers: I
Y N
so, Lisl: 1 q r
Varianc :
If so, List:
TSO 'sY/ /N
, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3