HomeMy WebLinkAboutCLE201000085 Review Comments Zoning Clearance 2010-06-01(BBli
11��YicCit1 ®11 !i ®�iYY� Clearance
Application
CLE #,
:C L
�/RGIN�P
❑ Zoning Clearance = $35
OFFICE U E ON LY
Clieck # mRq I Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 99JUA Staff:
PARCEL INFORMATION - - - - - -
Tax Map and Parcel: Q (,o G y 00--ADO ( 0,Q Existing Zoning
Parcel Owner: c-, 13 VL,-!� L_L Cam`
Parcel Address: 3gg t S<,t, ,, �o i c- f r • City. � y 14 State y CA Zip 22-9 1 I
(include suite or floor)
PRIMARY CONTACT r A
Who should we call /write concerning this project? L n
Address: C&ind O X.1 1 &9_ 'City J t j u State UL, ZipZ L q ti 7
Office Plione: ( 40-571-L Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Sy, 1; r-3 ' S < < � � E{ � �✓ � -f
Previous Business on this site 5'bv_
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 accurate to i best of my knowledge. I have read the conditions of approval, and I understand them, and tthha+t,I will abide by them.
Signature Printed
APPROVAL INFORMATION
Approved 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
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
Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use: A
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N �'
ermitted as: _��S,v�•,�! `, �G Y/ A/
Y/N
Will there be food preparation?
/
Under Section: A J i AJ ,P C
If so, give applicant a Health Department form.
SP's:
Y/N
If so, List:
Zoning review can not begin until we receive approval from Health -
Supplementary regulations sectiona - - -
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well or public water?
Clearances:
SDP's
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnin4 to emmnlpte the fnllnwino:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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