HomeMy WebLinkAboutCLE200800210 Review Comments Zoning Clearance 2010-07-19A.pplicati ®n for Zoning Clearance
CLE # (DO
F1 Zoning Clearance = $35
OFFICE USE O LV / / -,%
Check # Sate: l u
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff': _
PARCEL INFORMATION _ `, ((�� rr
'fax Malt and Parcel: 3a e �°' existing Zoning aml , of TFt c-
Parcel Owner: %'- �(.d"►'i
Parcel Address:��,�, � Clty�./'1.�L�13�Q�iY2�(�/' State Zip Z P
(include suite ol• flool')
PRIMARY CONTACT l J ` ,off
Who should we call/write concerning this project? �iy/r /T Ic-r
Address: sAq/ne, City State Zip
/ /
Office Phone: (Y3 77 Cell Fax # E -mail (3.efr(����t+r'�.>V'P�tIL y'o
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Nalne /Type:
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 ipformation that you can provide,
Lol
*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 [hat I own or have the owner's permission to use the space indicated on this application. I also certify that the infonnation provided
is true and accurate bpest of illy knowledge. I have read the conditions of approval, and I understand tier, and dial I will abide by them.
Signature i� �/ - Printed Sl✓%t 1 R4ALA
APPROVAL INFORMATION.
Approved as proposed [ J Approved with conditions [ J Denied
[ J Baci flow prevention device and /or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ ] 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 i `i t.b
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
Ed
C�� 111-n
Intake to complete the following:
Y /I'
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / 'b
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from IIcalth
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or 1 blic w. r?
If private well, provide Health partment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie�
Is parcel on septic or;�� r9
Y/
Will 4 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# i7–°'
Reviewer to complete the following:
Square footage of Use: ✓
1) N
Permitted as: 4e tJi S45; 1 �'
Under Section: �23. -z''
Supplementary regulations section:
Parking formula:
Req 1sire d spaces:
Y
Items to be verified in the field:
Inspector:
Notes:
Date:
— -
Vio ions:
Y /'
If so, List:
Profftr;s:
Y T
If so, List:
Van ce:
Y �N
If so; List:
SP's:
1' /
If so, List:
Clearances: � �
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3