HomeMy WebLinkAboutCLE201000086 Review Comments Zoning Clearance 2010-06-01M
Application i ®r Z® ing Clearance
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CLE# 2
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❑ Zoning Clearance = $35
OFFICE USEONLY
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # n Staff: Wa
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PARCEL INFORMATION -- -- - - - -
Tax Map and Parcel: c M i go UJ ,.�a7 O n o Zo Existing Zoning
Parcel Owner: Wes, 11+ a ,.Y. 1yl.Cv� n J
Parcel Address: --1,U - �1 C-i —CUY State V Zip22-9 t 1
(include suite or floor)
PRIMARY CONTACT
/write
Who should we call concerning this project?
Address : q Ck4v4 City State Zip ZLg (!
Office Phone: �) Z-�i L ' 1�t �1 Cell # iD�'S'77 t- Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: P�t t S — .Scl I
Previous Business on this site ? ov-, & t_A"y S &—_
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, 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 e Uest of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed ( _Ar �� : S—' J'T
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacl&ow 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 c_ Date o
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:
Y /T
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/I
Wil there be food preparation?
If so, give applicant a Health Department form.
Zoning review cannot begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o publi�wa ?
If pri vate well, provide Hea t form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies__
Is parcel on septic • r- public sewer9
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 #
Zonine to complete the following:
Reviewer to complete the following:
Square footage of Use:
0e/N
rmitted as: lO ! , VA /.' Pi✓
Under Section: 1.
Supplementary regulations section:
Parking formula:
S " "/ fi c- 'RM ,N
Required spaces:
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ons:
Y/N
If so, ist:
Proff s:
Y �N
If so, List:
Varia e:
Y /N)
If so, List:
SP's:
Y/
If so, List:
Clearances: Q�
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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