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HomeMy WebLinkAboutCLE201000150 Review Comments Zoning Clearance 2010-07-26e� Application for Zoning Clearance `'''y CLE # - 16 — � 56 Q hT) Zoning Clearance = $35 OFFICE USE .ONLY Check # I 114A Date: 7' Receipt # Staf'f': PLEAX REVIEW ALL 3 SHEETS - PARCEL INFORMATION '��n _ _ Oq 'fax cr Existing Zoning Map and Parcel: �,l/ L. L- Parcel Owner: 1. (. e 6fmmio' State V Zip 20 Parcel Address: li (include suite or floor). PRIMARY CONTACT r� P«� kC1.71.1'V1CA I" Who should we call /write concerning this project? �/ �a� Chaw Ave City — t V 1 tj State Zip 2 Address: { "",V Office I'hone: �� IJ x(07 Cell AOS106-106 # E -mail �vtmma -8. Pam © q APPLICANT INFORMATION Check any that apply: Change of ownership 4V Change of use Change of name New business Business Name /Type: Sl0 ow COhu S1-0AjL Previous Business on this site ulyl0 &6 Shn-e- 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 information provided is true and accuratckrTpe best of illy knowledge. l have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed D�lff:�tiVMq TCC,�tt ��zO APPROVAL INFORMATION [ 'j01 Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow 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 V Date "j ZZ,it i Other Official /`W 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 VZ Intake to complete the following: 1'/1\� Is u n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Reviewer to complete the following: Square footage of Use: �0 0/ N 1) fie, C /VJnJ CO AA11 h: Permitted as: �!✓ 1' /N Will there be food preparation? I Under Section: -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 Is parcel on private well or wa ei Parking formula: Required spaces: If private well, provide He neat form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Y/ Items to be verified in the field: Is parcel on septic or p 'sew Var ce: Y/V If so, ist: Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: Y / N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Clearances: Permit # SDP's Violations: Y. N If so, List: v Prof s: Y / ; If so, ist: Var ce: Y/V If so, ist: s' Y/N If s , ist: Clearances: SDP's Revised 04/28/08, 10/13/09 Page 3 of 3 I 1 � a a I C67 Cou &NQ-n. 4CL-d &Wdot-e ullle -, VA ZvgO2 150D S