HomeMy WebLinkAboutCLE201000084 Review Comments Zoning Clearance 2010-06-01O�JU -b3 - 66_ona?e�n
Application for Zoning Clearance
CLE #
❑ Zoning Clearance = $35
OFFICE + O
Check # 1Q� Date: lo 16
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff.
PARCEL INFORMATION.
0 (0 � o - 0 31 00 - oc) 7,0
Tax Map and Parcel: Existing Zoning -
Parcel Owner: 1,��� ► \
Parcel Address: 3C�o � � r_X6*_ City CH' "KI State U(4- - Zip -
(include suite or floor)
PRIMARY CONTACT jf
Who should we call /write concerning this project?
Address: ', U CGw�� �t a Q City 1% SW <<-k_ State
Office Phone: L 61 Cell # 9G'0-57)J- Fax # E -mail
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
_Change
Business Name /Type: C -- r �_J
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:
*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 accurat t 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 n.�-�
APPROVAL INFORMAT N
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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 �� (' ,t t,�
Zoning Official Date / /z/ t7
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 Page 2 of 3
Intake to complete the following:
Reviewer to complete the following:
Y a Square footage of Use: Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N ) 1
�, Permitted as:�aa.�l
Y
Wil ere be food preparation? Under Section: tJ� i v
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 r public war?
private well provide H al;;i; a�'rtment form.
If p , p p
Zoning can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or pil6lic sewer
Y/N
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 complete the following:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/0
If so, List:
Proffe
Y/
If so, ist:
Varia ce:
CN If so, List:
PY
:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3
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