HomeMy WebLinkAboutCLE201000102 Review Comments Zoning Clearance 2010-05-28IV/ `V/ W
Application for Zonin Clearance
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(Zoning Clearance = $35
OFFICE USE O
Check # C /� Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # ` Staff:
PARCEL INFORMATION
OW S�
Tax Map and Parcel: Ptarcel 000000/2300 00 Existing Zoning
Parcel Owner: Cr, �%5SOC,'o�rs /%�angq�C+ rJy 7Juvn�ar•fe.h / tc�tr r•'Q'S'
Parcel Address: 6,06 /�I,6t;n -,1,e Ss:ua:rt City State Vri Zip W96/
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? /3r% 7V CA e w
2i29Lr
Address: ;L 3 �j 2 S iErt- e r V w oo� Per kt ,--, v City f iL � � Pi��l State V., Zip
Office Phone: (° y) .213- L// 09 Cell # V I .i E /9-'1414Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Non P J,4- - Ter,Y
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u',"r 0 fi' Ca �`,r - %�G�'✓ s n o �►
Previous Business on this site -'u',",
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: `� e , �,1�; ��s - i SAX4..r o 5 nr y(IlC1,0q,-
/- L ve k"e l.es . Ndn QL,- f - I>t a
*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 knowledgie'. I have Tread the conditions of approval, and I understand them, and that I„wiilll abide by them.
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VP P( e/!S
Signature x(�,�tre(Nl Q)Sk li>�!1•, Printed �I ,�lC� G'
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 -'s, 1 �, (,, c rt J
T
/
Zoning Official �✓ Date ::EI�1 /A
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 /�L/.
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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 . ublic 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 ublic sewer
0/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
8Y /N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 6,,'i0 10 -8OYA2
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: ' -25-(%
fy N /
ermitted as: /'4 I C,c
Under Section: •�-S `�
Supplementary regulations section:
Parking formula: jl
DJ ry
Required spaces:
Y/
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y /
If s ist:
� pffers:
(Y // N
f so, List:
Variance:
Y/A
If so, ist:
P's:
/N
f so, List: l 7 q 3
Clearances:
AAA
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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