HomeMy WebLinkAboutCLE201000152 Review Comments Zoning Clearance 2010-08-10Application for Zoning Clearance
U d
1•hIf11N \N
�
M`Loning Clearance = $35
OFFICE USE ONLY
Check # �_ 3 �— Date:
PLEASE REVIEW ALL 3 SIIEETS
Receipt # TC �' Staff': e"L) Lj;
PARCEL INFORMATION [ / Q 00-00
Tax Map and Parcel: () &B V-' 0b CExisting Zot►ing
J A" 2
Parcel Owner: -4cl -N
•�` 1- n I`�ito Uri zip
j �� (irvt��cb-c�
Parccl Address: Co�it
(include suite or tloo►•)
PRIMARY CONTACT t 1 -enclw �p b
V U �C���I
1�Vho should we call /write conceruin 7 this ro, ect`> P .�Vl '5C6
6 p i
Address : 'vim` t° city llte V zip _
Office Phone: () -� 2ci Cell # 'WQ(0 7qq V Fax # E -mail
APPLICANT INFORMAT
Check any that apply: , nge f o nershi Change of use Change of name New business
Business Name /Type:
Previous Business on this site �� k
Describe the proposed business including use, number of emplo es umber of shifts, a ailab a parking spaces, num er of
vehiclesi and any additional information that you can provide: If,WI`C�CC.. ' 1 P.j��bi.S l•G�s':
t
*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 die best of my knowledge, I have read the conditions of approval, and I understand them, and•that I will abide by them.
Signature �I n`, Q= � Printed M ca- �� �u
APPROVAL INFORMATION
Approved as, proposed [ ] Approved with conditions [ ] Denied
] Backflow jirevention 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
Zoriing Official t&r 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/N
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will there be food preparation?
if so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies ���1�,�--_�-L_�
Is parcel on private well or
If private well, provide Health Department form,
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on septic public sewer?
Y/0
Will you be putting up a new sign of any kind?
Sign permit.
Permit # av U-
Reviewer to complete the following:
Square footage of Use: IJ~U
CY N
Permitted as: ) "l"
Under Section: -5•-,
Supplementary regulations section:
Parking formula:
Required spaces: _ \
It /
Iten e verified in the field:
If so, obtain proper
Inspector : Date:
Notes:
`mill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # g D �'� / cg-• ,-j q
.10%o
7nninrr to rmmnlatP tha fnlinwinoa-
lations:v
If s N
If so, List:
P offers:
Y�
Ifs
Varia ce:
Y/
If so, ist:
S s:
/N
so, List: Z
�Z
Clearances:
/
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3