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HomeMy WebLinkAboutCLE201000174 Review Comments Zoning Clearance 2010-09-01Application for Z®nin Clearance _# CILE 4 Ydo - Clearance = $35 OFFICE USE ONLY 9 Check # Date: 4 (Q PLEASZoning REVIEW ALL 3 SHEETS Receipt # :FCCL14 Staff: PARCEL INFORMA ON I L I 0 - b 9 —b6 `QC) Tax Map and Parcel: J6D Existing Zoning 1 96Cy ut Parcel Owner: ri rr Parcel Address: /2 City C"i�e-'l-gze 'State / Zip�e, (include suite or floor) PRIMARY CONTACT ,,�� /+ G�> Who should we call /write concerning this project? // /_ e.:_ Address /V J—i`— City I/e State �sf ' / 04 4sk- c© /,v C,4S4 dp Cell # �4 �O Office Phone: Fax # q -Z E -mail AfAll, APPLICANT INFO ON Check any that apply: Change of ownership Change of use V Change of name New business Business Name /Type: of Previous Business on this site 114117"" 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: _� C 51i�% %/�fi�kh%4— S- 9 —k-d -S *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 the best of my knowled ,have read the conditions of approval, and I understand them, and that I will abide by them. Signature �25'Lee-e-e-_-,> P rinted l/l✓'���'��"'' APPRO INFORMATION V.4roved as proposed [ ] Approved with conditions [ ] Denied [ JBackflow 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 (;a Zoning Official /L✓ 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 use n LI, HI or PDIP zoning? If so, give applicant -a Certified Engine is Report (CER) packet. (9/ N 1 Permitted as: Y/ Will Vre be food preparation? Under Section: Z�•Z�1 If so, give applicant a Health Department form. Zoning review can not begin until we-receive approvatfrom Health Supplementary regulations section: - - Dept. FAX DATE Circle the one that applies . _ _ _._ _ __ _ Parking formula: Is parcel on private well or lic water? �7 If private well, provide Health en orm. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Circle the one that app Is parcel on septic o ublic sewer? 'Y /N —Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / Will Le any new construction or renovations? If so, obtain the proper Permit. Permit # 7nninv to rmminlPtP the fnllnwin¢: Y N Items to be verified in the field: Inspector : Date: Notes: Viol tions: Y� If so, ist: Pro s: Y /LJ If so, List: Varia e: If so, List: SP's: If so, is t: Clearances: /-1,4vy/ SDP's Revised 04/28/08, 10/13/09 Page 3 of 3 r, C 1S 1 'v