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HomeMy WebLinkAboutCLE201000181 Review Comments Zoning Clearance 2010-09-22Application for Zoning learance`_ 9 Al, /�� `` O_ CLE # 2D '� ,:. E] Zoning Clearance = $35 OFFICE USE ONLY /� �/ Date: Check # U Receipt # Staff: PLEASE REVIEW ALL 3 SHEETS PARCEL INFORMATION V) 10 Z Opt 00-t 0 0 Existing Zoning Tax Map and Parcel: (D" Parcel Owner: VC - f" Aj �. 1A. INiy Sti�heA, Tlal[� S�•2City 1SJ�l State V 11' ZipZ2901 Parcel Address: (include suite or floor) PRIMARY CONTACT L1 '/�/j c, 14r e �0A l 4, 4 Who should we call/write concerning this project? , 1 Address : 1 I 1 H kccd C•- l l e.c { 5�t . Z City &,r-L 141' u c. State VA.- Zip Z 2,101 Office Phone 3i 70t- Cell # Y ?Y- Y*- PZLFax # 96 - M- Ml E -mail W M2�on14�- � 4 J C-A p file . COA APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: 6r_&J S�r��cQ�, C�R��ti�LLC �tcis�t�e� �T� ✓�t��t.,� /�i�ilJ�ia�� ��K Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of ;rn vehicles, and any additional information that you can provide: jUg' jk .,L it\Aw,kMe-.f 4d" .1M U +il'ti� 404"%j t 'AhLe j Ar/ Nr�4 Z- 3 c.l- r acl! *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 Alier l-- 10,0 j94t. APPXOVAL INFORMATION [ ]Denied [ Approved as proposed [ ]Approved with conditions [ ]_ ckflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117. [Vr'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 Datea Other Official Date q -0unty U Li1Ue111a110 1JGl1a1111-11L v1 a.va ..... ......� '­---r­----- 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: © �1 I Y /NqSquare footage of Use: Is use m LI, HI or DIP zoning? If so, give applicant a Certified Engineer's Rep t (CER) packet. / N ermitted as: !U + l Y / Will t re be food pr paration? Under Section: If so, give applicanYa 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 - Par g formula. - : 5'& 6 - Is parcel on private well ublic water? OL C-P �IPk If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE YIN Circle the one that applies Ite s to verified in the field: Is parcel on septic o ublic sewer? Y / Will u be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y /N.., Will ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Notet: Date: Zoning to complete the following Viol io s: Y/N If s Prof Y/ If so, ist: Var' ce: is N If so, ist: SP's- Y /n If so, 1st: Clearances: SDP's Revised 04/28/08, 10/13/09 Page 3 of 3 - � � • art- N+ �t�r •tn��l•�rw3...�-r�r�rto-�aac��'V �..� ►- _ - :ponaraar PA U' R4 ! F NVId-LIAan OUVW3HD Aga A2� I DNt033JOtld 3tlDi38 S3QWd3bJSIQ !0 LO311NJtlr AdLLDN DNY.3BS IV SNOt6N3Wt0 Ailtl3n 01 801DYtl1NOD Cl > rt� J J t%a t � i V 4 I �yo z..10 Li fl 14 t(�