HomeMy WebLinkAboutCLE201000151 Review Comments Zoning Clearance 2010-11-29Application for Z®nin Clearance
OFFICE USE ONLY �o ��� �
Zoning Clearance = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff':
PARCEL INFORMATION,
-
Tax Map and Parccl: Co Existing Zoning
Parcel O1V11e1': " r'Cry'/�
Parcel Addl'ess: G. ' V"'� /Z'D City tate ✓4—
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
1
Address: ('� �� City el 4--t " State V -- Zip -415�O
Office Phone:' ?�) ??(p Cell #'IPI +3 % Fax # 2T�a ►nail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:�� -
Previous Business on this site O/�
k
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, anew 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 infonnation provided
is true and accurate to Llle best of iy knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them,
Signature Printed
INFORMATION
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, 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
Zoning Official Date / t�
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
e Cd'Z
Intalce to complete the following: Reviewer to complete the following:
/ Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N
as: C�
Will there be food preparation? Under Section: �f� • s'6)
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
Circle the one that applies
rarlang rormuia:
is parcel on private well or i li er?
Required spaces: / L�
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
1 /
1' /N
Circle the applies
Items to be verified in the field:
Is parcel o epti or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
Inspector : Date:
Or/ N
Notes:
Will there be any new construction oi• renovations?
U -
If so, obtain the proper Permit. -
Permit # 2—/)d - -• /f <U til
2.0 ,
vfolati ns: v
y/6)
If so, ist:
Prof
Y/
If so, ist:
Vari�aqce;
Y
If so, List:
s:
Y/N
If so, List: �v &
Clearances:
SDP's
U -
2.0 ,
u�
Revised 04/28/08, 10/13/09 Page 3 of 3