HomeMy WebLinkAboutCLE201000171 Review Comments Zoning Clearance 2010-08-30S
APPROVED
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Application earaT".
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OFFICL � SE O h
Zoning Clearance = $35
PL_""'l REVIEW ALL 3 SHE, ETU
Check # Date:
Recelpt # Staff:
PARCEL INFORMATION/�
Tax Map and Parcel: ��y5� DxistingZoning
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Parcel Owner:
ity State Z1132MI
Parcel Address: Vv _
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: Q• City �SUKfState U61 Zlp ZZq
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E -mail
Office Phone: q cell # ! "_V61V1
APPLICANT INFO ON
Cheeit any that apply: Change of ownership of use _Change of name Ne)v business
�C jhange
BusinessName/Type: ffi r
Previous Business on this site S
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, a new Zoning
Clearance will be required,
I hereby certify that I own orhave the owner's permission to use the spaceindicated 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,
Signatur Printe4� i (Ztg �n ' 0z o
APPROVAL INFORMATION
�Approved as proposed [ ] Approved with conditions [ ] Denied
l J Backfiow 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 _ t t Z)
Zoning Official Date��d
Outer Official Date
County of Albemarle Departntout 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
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Intake to complete the following:
Y /
Is us I, HI of PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
ill 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
Is parcel on private well or, ublic water?
If private well, provide Hea nt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or p lic sewer?
Y /
Will e putting up a new sign of any kind? If so, obtain proper
Sign p rmit.
Permit #
Y/N
Wil e be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followinLn
Reviewer to complete the following:
Square footage of Use:
�)/N
Permitted as:
Under Section:- -2' I
Supplementary regulations section:
Parking formula:
Proffers:
Y/
If so, ist:
Required spaces:
Y/
Items be verified in the field:
Inspector :
Notes:
Date:
SP's:
Y/�
If so, List:
Violajions:
Y /(IN
If so, ist:
Proffers:
Y/
If so, ist:
Variance:
Y "/N
If so, ist:
SP's:
Y/�
If so, List:
Clearances: l� I�
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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