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HomeMy WebLinkAboutCLE201000169 Review Comments Zoning Clearance 2010-08-25Applicati ®n for Zoning Clearance �IRCtN�� ❑ Zoning Clearance = $35 OFFICE NLY kJ� Check # Date: PLEASE REVIEW ALL 3 SHEETS j Staff: Receipt # 14Y)jr PARCEL INFORMATION - - - -/Y- 1-7 Existing Zoning Pbs c✓ Tax Map and Parcel: Parcel Owner: yL i� �jJ ye_ Parcel Address: Q �S �� City State �1 Zip Z271( (include suite or floor) PRIMARY CONTACT ilk Who should we call /(write concerning this project?,�} /+� ,/�I� Address: FJ3� TUA! ��L+ �AZ� ( City- VLQG+�� C� State t1 PC Zip�f Offlee Phone: U cell Ljg? OQ6 Fax # E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business �j Business Name /Type: `iy Tai Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of A<% vehiclesI,O0and Qany ®additional information that you can provide: svv��tv�Lty�' f It 1 i ' ©[K tl-4 u#— S 16X(o '�Q l�'�. fc. C�l 0� IV& e �:i� o$ tiff & : '� ' . , S � 1 wr° 3 �v, DT *This Cl rance will only be valid1bn the 16rcel for which it is approved. If y& char 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 agurateA th e best of my knowledge. I have read the conditions of approval, and I understand them and that I will abide by them. Signature $�41�x� Printed APPROVAL INFO ION 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 414 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: Reviewer to complete the following: Y / Square footage of Use: Is u in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. )l N /_ ermitted as: C4,1 y Y/N n 1 Will there be food preparation? Under Section: A R M i YA L +/ 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 ublic �mentforrn. If private well, provide Health pa Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that apply Is parcel on septic or pubm S_eew Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7nninu to emmnlP.tP. the follnwin¢: Parking formula: Required spaces: Y /. Item e verified in the field: Inspector: Notes: Date: onf s: C If so, ist: Prof If / If so, 1ist: Varian, e: Y V If so, List: SP's: Y/ If so, List: Clearances: SDP's 1 Revised 04/28/08, 10/13/09 Page 3 of 3 - —j N 0 jq O J s v�