HomeMy WebLinkAboutCLE201000185 Review Comments Zoning Clearance 2010-09-17I
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Application f ®r Z®nin Clearance
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CLE # Zn i o " /p
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vIRGIN�P
Zoning y] Clearance = $35
OFFICE USE ONLY—
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
-- PARCELINFORMA'I'ION - --
Tax Map and Parcel: � _b/01— O ��� ����j Existing Zoning
Parcel Owner: R o u t d- Car-her
Parcel Address: I z S'1 Orl -( & d city G�►�rlo-li �SV:I1e State 1) A Zipatq/c
y �e
(include suite or oor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : 9�l i �l Ci eQ k City State N / Zip rD
� 3u—
Office Phone: Cell # ::H/01003 Fax # E -mail I( /y uj w 4-i 6-y hrrima .
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: vila. 1 10 yi ri e e ('V i u
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: I (jwnt ( I e M41 ayct (� t I �- r �010u {d) i� L Lai
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 1✓1 a r y 1N4 1 I-e'r
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 /O
�, /�
Zoning Official Date 2/ / Llyp
rr
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
701
Intake to complete the following:
Y /kIs u I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will ere be food preparation?
i If so, give applicant a Health Department form.
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or public water?
If private well, provide 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 septic or public sewer?
Y/N o
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /WT
Will Wre be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy to complete the followintF :
Reviewer to complete the following:
Square footage of Use: % .
/ N
Permitted as:
Under Section: Z V •' ✓
Parking formula:
Required spaces: /J
Y/N !�
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ions:
If
If so, ist:
ffers:
/N
Ueso, List:
Var e:
)(
/�
If so, ist:
SP's-
Y/c
If so, st:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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