HomeMy WebLinkAboutCLE201000176 Review Comments Zoning Clearance 2010-09-02CC
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Applicati ®n for ®nin Clearance
CLE # -7
�IRGIN�P
omng Clearance = $35
OFFICE USE NI�Y &)
Check # Date: 7
PLEASE REVIEW ALL 3 SHEETS
Receipt # �"nr) Staff:
PARCEL INFORMATION
Tax Map and Parcel: o l - % A Existing Zoning
6
Parcel Owner:
Parcel Address: Rovq <&f City ' .ems �/ State V A Zip—&tb
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: IC�2�U, - �n'�i�'_. City Ckg,,J �S„ Al State \X Zip ZZ_M
Office Phone:( r) Fax # E -mail
APPLICANT INFO ON
Check any that apply: of ownership Change of use Change of name New business
n'Change
Business Name /Type: & Y y J (—�� P(6 VI-
a --Previous Business on this site
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: ! (zyvyw,2 , P
*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 pemrission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
best
Signature • Printed
APPROVAL INFORMATION
j 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 r —� Date o
Zoning Official Date 12—
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
C..
1 f) - 1>
Intake to complete the following:
Reviewer to complete the following:
Y /�
Square footage of User
Is i� in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
�ern�tted
as:
Wi} t re be food preparation?
Under Section: �J i1.1 -•
f
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 _ __. _ -- __ _ _ .. _
Parking formula:
Is parcel on private wel public wa er?
If private well, provide lth D ment form.
Zoning review can not begin until we receive approval from Health
Required spaces: / 2
Dept. FAX DATE
�� J
Circle the one that app i Items to be verified in the field:
Is parcel on septic r public sew
Y
Wi ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y / Notes:
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7,nninu to emmnlete the fnllnwinu:
Viol' ns:
If / l J
If so, , a- t:
Pro s:
Y
Ifs st:
Vari ce:
Y/
If so, ist:
SP's:
Y/
Ifs OLei st:
Clearances:
ND�t/
SDP's l
Revised 04 /28/08, 10/13/09 Page 3 of 3