HomeMy WebLinkAboutCLE201000092 Review Comments Zoning Clearance 2010-05-20Application for Zoning Clearance
CLE # � % O -- qA
I*—
Zoning Clearance = $35
OFFICE USE ONLY
Clieck # 55 Date:'r�
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff.
PARCEL INFORMATION J� C
Tax Map and Parcel: ! LP OD —G G i 3 (5 Existing Zoning
Parcel Owner: (-55(�Gl Lti f[_J
Parcel Address: 1 5�) i� iC7 (� City U JICState V A Zip
(include suite or floor)
PRIMARY CONTACT
14
Who should we call /write concerning this project? P _nc- [,,��
Address: i7 ' �� /� City C Q l i I k State 0 l Zip
Office Phone:(_) /:Y-)V7595 Cell # Fax # E -mail 1 fA ei f-re A-6J(','�e e+k 10 t
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
'L+D &I
Business Name /Type: �Oi-. t"T�
' L(-)-')j'31 Z DI D
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: ALAI-0, - e-ik: Jc' Le-
c�_t.� � T1 u
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 know l ge. I have read the conditions of approval, and I understand them, and I will abide by them.
Signature V Printed [tea/%' i l L'5
�j
AP R i VALE INFORMATION
as proposed [ ] Approved with conditions [ ] Denied
�1Appro
1 Bacl<flow 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 �jt
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
!1
Intake to complete the following: Reviewer to complete the following:
Y / O Square footage of Use: Z f1Ykl
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. 'V/ N n
Permitted as: daye,� 'V
Y �tiere Will 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 o �Eebp)artment ater?
If private well, provide Healt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or f ublic s wer?
Y/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # -G l)f0
Y /aWil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to rmmnipip the fnilnwina.
Parking formula:
Required spaces:
Y/
Items be verified in the field:
Inspector : Date:
Notes:
Viol ions:
Y/
If so, ist:
Proff rs:
Y/N
If so, List:
Variance:
Y0
If so" ist:
SP's
Y/
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3