HomeMy WebLinkAboutCLE201000168 Review Comments Zoning Clearance 2010-08-23wa�'
Application f ®r Zoning Clearance
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CLE #
OFFICE E ONLY
❑ Zoning Clearance = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map Parcel: � " f Existing Zoning
and
Parcel Owner: U `� L.C. C-
Parcel Address: "1? <12 ✓z �e Her? ir.L�-rJ 12/O City K LSca 1 C --r , State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project ?,
Address: 4122L6- e-0 City State Zip
Office Phone: 4( n Z 1.31 /w Cell # Fax # E -mail
APPLICANT INFORMATION '
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: A'lm ls' C Q u,"'T�V ,oa'/ /f4 )L" 'E ! (f-
Previous Business on this site Q C3 � /J ►)- (Z E" 227 Aelr, ,f (,— 9
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: iy 1 L L
y -6- .,�, 1-c s° 4 Y cc S (- -S H i I-; /P
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew 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 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 Printed P, . L'_ S1 M . /� ,IA hAzei
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
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
Intake to complete the following:
Y /lU
Is u e n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
(LYjI N
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 o�tiv, ies Is parcel o e well r public water? If private wvi e 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
ptic or public sewer?
Y /
Wil you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/O
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to cmmnlete the fnllnwinu:
Reviewer to complete the following:
Square footage of Use:
Y Y N
rmitted as:
�o4.,t/ y 54z
e, (,V6)
0241-12\'\%
Under Section:
/1)
Supplementary regulations section:
Parking formula:
Required spaces:
Y
Ite be verified in the field:
Inspector : Date:
Notes:
Violations:
Y 1A
If 4L)ist:
Proff
Y/
Ifs ist:
Variance:
Y ast:
If s
SP's:
Y/
If so, List:
Clearances:
SDP's !!>
Revised 04 /28/08, 10/13/09 Page 3 of 3 -'I