HomeMy WebLinkAboutCLE201000081 Review Comments Zoning Clearance 2010-05-11Application for Zoning Clearance
CLE #
Zoning Clearance = $35
OFFICE USE ONLY
Check # % WO Date: / 7 -,
PLEASE REVIEW ALL 3 SLEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 05 '" b� ^ b d� ��� Existing Zoning COW""
D As j
Parcel Owner:
Parcel Address: 3Z S F—ovr Lea 4iW city lik State VA Zip 22916)
(include suite or Hoor)5u j � G. 11 -(3
PRIMARY CONTACT C Z G� t mil'
wl (,,,
Who should we call /write concerning this project?
`Z�G3
2SS0 TUrK2� P.�c?c�c "�/,
Address: City State Zip
"i3 l Zvi "_J�'�%� (q3q) �MCL�IS
Phone: L� Cell # 1-+f q— i b 1 3 Fax # E -mail 5
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: F j 1 Z aA, zl'Lj
Previous Business on this site Cv rre,, 41 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: 6h,?- 'l.tv1 l(a D t71 �,i T � u n('- V ekiCk,
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*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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature _ Printed af L l --_70_b e-1
APPROVAL 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 Date
Zoning Official 4 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:
use in LI, HI o A PD mooning? If so, give applicant a Certified
Engineer's Report�M) packet.
Y/
Will E 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 or6u lic 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 lic sewer?
Y / N Nj(
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 comnlete the followinLY:
Reviewer to complete the following:
Square footage of Use:
_0 N )
Permitted as: %�1.�i cry/
Under Section: C
Parking formula:
�66 'i'
Required spaces:
Y/
Items to be verified in the field:
Inspector: Date:
Notes:
/ N
f F 'o lations:
so, List:
Proffers:
(�/ N
Vso, List:
Va e:
Y�
If so, List:
SP'
Y/l
If so, List:
Clearapces:
4A.,
SDP's y
Revised 04/28/08, 10/13/09 Page 3 of 3
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