HomeMy WebLinkAboutCLE201000131 Review Comments Zoning Clearance 2010-07-19Application -for Zoning Clearance
CLE #
Zoning Clearance = $35
OFFICE USE ONLY ll
Check # 1072, Date:
PLEAsk REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: LIS - f C Existing Zoning C
``
.Parcel Owner:— 1 v(� t'1 S C 1,.. L C
` ` zzgc/
Parcel Address: 2025' W O.A.0 -A ur City t! hCa, uAfjd j IR State '% ll Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: X o 2 5 W OOA'rco � Q-1 City l 6,. ! 4-le r )" State V A Zip
Office Phone: (�) q % Cell# Fax# E -mail C�M/�{eil�r�Sertl(,Ct
APPLICANT INFORMATION
Check any that apply: Change of ownership 1/Change of use Change of name New business
Coma We � dee se-.9.Q
Business Name/Type: v 1, Ces,
? ?
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 dditional information that yqqu can' provide: .- sw� v o - V,c ® r.dua' ./i
Me�'c� e c�_s,�e V; c� R�r-rd,+�
*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 conditions of approval, and I understand them, and that I will abide by them.
Signature AtL Printed AP-111u r G S ocki yv _-:T42
APPROVAL INFORMATION
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. i I
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
�k�� n Revised 04/28/08, 10/13/09 Page 2 of 3
Intake to complete the following:
Reviewer to complete the following:
Y /
L,
Square footage of Use: �� U
Is US HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
N
Y/
rmitted as: �,A n, r=b { ua/
Will r 'be food preparation?
Under Section: �� 2• I
If so, give applicant a Health Department form.
SP's•
Y
If so, ist:
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or I lie water.
Parking formula: [
If private well, provide Heal epa ent form.
Zoning review can not begin until we receive approval from Health
Required spaces;.
Dept. FAX DATE
Y/
Circle the one that applies
Item o be verified in the field:
Is parcel on septic or pu lic sewer?
Y /
Wil u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector • Date:
Y
Notes:
Wilre be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZOninL to comDlete the following:
Vi s:
Y/N
If so, ist:
ffers:
Y N
so, List:
Varia ce:
Y /
If s , ist:
SP's•
Y
If so, ist:
Clearances:
_SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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