HomeMy WebLinkAboutCLE201000121 Review Comments Zoning Clearance 2010-06-23Application f ®r Zoning Clearance
CLE al
� %RGIN'
❑ Zoning Clearance = $35
OFFICE U L'1'
Check # bate:
PLEASE REVIEW ALL 3 SHEETS
Receipt # " Staff:
L
- PARCEL INFORMA
Parcel: ����� Existing Zoning
Tax Map and ty -(,(� Gh) l�
Parcel Owner:
Parcel Address: �� 6��i� mA� `AC . City cN9'0T"�S`r`4State uA Zip 01, 216
(include suite or floor)
PRIMARY CONTACT
����
Who should we call /write concerning this project? f-1U:r i�—. My L"r6�
Address: ��� S. f0QS08013 Sr City F'TCdW0/10 State U Zipo23
Office Phone: 40q) Ala -0913 Cell # 20y- $gg'6ogq Fax # E -mail 4'(&Ui hayy i �►�C Qfyek
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Q Uii .rc_ S-ro S 1x u �vriu�� Ale
Previous Business on this site 01 AIL bas, ) D_T1SCUU►J-r )�(A121iJ -- LA kf_ RE
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: —&1 -S F rneLoy f'rS
/0 Mfk -so�-' maces xL) fRoA3T T�cc µA�rc�P ao -3o P I��G SP�c�
&F, jig M D 6wrl_ "�JG-
*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 he o er's permis on to use the space indicated on this application. I also certify that the information provided
is true and accurate o the best of y owledge. I e read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printedj2A
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 Pale 2 of 3
C .1u
A2
:G
T14X- L
��U9
printed on 30%
consumer recycled paper
i
---
-C-
-�-
f
- -- -
-#
- -7
-- ;
--
—1
--
- -
Q
i
Al
post
��U9
printed on 30%
consumer recycled paper
i� _ l i l �
R 11
7 IT11T
f -
1
EQ3i
N -ro
aJ T, C-
printed on 30%
post consumer recycled paper
i_i O
Oj
-- i
EQ3i
N -ro
aJ T, C-
printed on 30%
post consumer recycled paper
Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use: J 0�
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will'I ere be food preparation?
/ N
Pe mitted as:
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
- - --
Parking formula: 3✓b���
Circle the one that applies
Is parcel on private well o 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
Required spaces: s
Y s'
Items- o be verified in the field:
Is parcel on septic o public sewer?
N
Q
i/
ll you be putting up a new sign of any kind? If so, obtain proper
Sign perms'
Permit #
Inspector : Date:
Y./
Notes:
Will t sere be any new construction or renovations?
If so, obtain the proper Permit.
Permit �#
7nnina to emmnlete the Mllnwina:
Viol ns:
Y /(N )
If so, -ist:
Pro ers:
Y/N
If so, ist:
Variance:
Y�
If so, Lost:
SP's:
Y
If so, List:
Clearances:
SDP:s —�
Revised 04/28/08, 10113109 Page 3 of 3