HomeMy WebLinkAboutCLE201000130 Review Comments Zoning Clearance 2010-08-13Application for Zoning Clearance
CLE # 070 1 0 _r- 136
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�IRGIN�P
EP Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY 7
Check # 7 �O Date: '�Z
Receipt # 39- Staff.
PARCEL- INFORMATION L/r� y - - - - Sr
Tax Map and Parcel: Existin g Zoning
Parcel Owner:l% Vii 5(--T \7\a\\ 1 1 C-
Parcel Address: _J%1a, 'R,n VkA\ C City Ck yLkr-i �&Q State VA Zip &;n�
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? (ail ,�`
Address : I iCO)K �r y_C�t��lx� City �1l Q1'1[� State \da Zip -z
Office Phone: -1 (oCRx- .Cell # 1 oq 1 — tAl5)D Fax # 03 E -mail r-nkb d\ IzY`C1i')06� - C Om
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: M--
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:--- 1 ,Cr
i
*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 the best of my knowledge. I have read the cond' ions of approval, and I understand them, and that I will abide by them.
Signature Printed M,,)6e
APPROVAL INFORMATION
,601 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 1 l C0
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 /No
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. ,
Y /O
Will there be food preparation?
If so, give applicant a Health Department form.
b ' t'1 1-r Health
Reviewer to complete the following:
Square footage of Use:
N JPermitted as:
Under Section: % �` -2—
Zomng- review_ can-no t eg n un i we- receive- approva - om_ u rt ......., - „5........,.
Dept. FAX DATE
Circle the one that applies Parking formula:
Is parcel on private well or ublic wa e ? 1 f I, c
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or public sewer?
WD11 you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y: N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #t)ap10 /°+pY'
7nnin.r to ommimlata tha fn1inwina•
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
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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