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HomeMy WebLinkAboutCLE201000117 Review Comments Zoning Clearance 2010-06-23Applicati ®n f ®r Zoning Clearance CLE # 0D l 6 - /% os Zoning Clearance = $35 PLEA E REVIEW ALL 3 SHEETS OFFICE USE ONLY ris -i� Check # - i 1't _ Date: Receipt # —lq Staff: PARCEL INFORMATIO Tax Map and Parcel: Y �c> Existing Zoning Parcel Owner: / r—// 1Zi&c--e- /4 /ZV ©& / 11yC_- Parcel Address: Q�� �� G �J�� City C (�(LGG� State Zip (include suite or floor) PRIMARY CONTACT nr 2 ^� y L,&.0 To ��41 F �`-� 414/S Who should we call /writes concerning this project. .� J Address : f 0 n , 7 s City C ,74r /0 T l 7— Kn Ytate V"' A Zip 2 Z p Office Phone: (_� Cell # �V7R'j� �Z Fax # E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business j� Business Name /Type: y r * c 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 oyaicsz permission to use the space indicated on this application. I also certify that the information provided is true an -at7M the b of y owle e. I have read the conditions of approval, and I understand them, and that I will abide by them. Sign u Printed 3"d rC{ Q J V L 4.N APPR AL INFORMATION j/f 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 C 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 Intake to complete the following: Y / Is se ' LI, HI or PDIP zoning? If so, give applicant a Certified Ens neer's Report (CER) packet. Y Wil ere 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.public wa r? If private well, provide He lth Depa ent form. Zoning review can not begtrl we receive approval from Health Dept. FAX DATE Reviewer to complete the following: Square footage of Use: �7 N e rmitted as: 2c�11 ) Under Section: �S• y,{ Parking formula: Required spaces: Y/N Circle the one that applh Items to be verified in the field: Is parcel on septic or Glic sewe ? Y N Wi i ou be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: Y /� Notes: Wil ere be any new construction or renovations? If so, obtain the proper Permit. Permit # 7oninQ to complete the following: Violations: Y/N If so, List: n Prof' rs: Y/N If so, ist: Variance: Y/ If so, st: �% /N so, List: Clearances: SDP's L Revised 04/28/08, 10/13/09 Page 3 of 3 cv ." ............ ................... K ► yv-\ -Lc.c vv\,t C- LT 5�-vvcke cA e- (v d - (' - spc"c-e L- jAi L