HomeMy WebLinkAboutCLE201000207 Review Comments Zoning Clearance 2010-10-13c i
Application for ZoninF Clearance -,
CLE# ��I� '9
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Zoning Clearance = $35
OFFICE USE ONLY
Check # Date:
Receipt # Staff:
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PLEI REVIEW ALL 3 SHEETS
PARCEL ORMATION /, 1�
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- Tax _Map- and_Parcel:_ ��/__ - _ Existing Zoning_
Parcel Owner:
Parcel Address: 07b 3 ��`� /7-t� I C Pn(ir amity ky), VL' State 14 Zip
(include suite or floor)
PRIMARY CONTACT a
Who should we call/write concerning this project? cs r-1 iy
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Address : I (i Ck 11 6'FA rm Cij,_ City Cky ;- f1A_ State Zip Z 7-
Office Phone: tl_? .29L - e77YCell # �9 7 �-11 / 7 Fax # ,� 6--73 77 E -mail MP.-"G04 � S,oec S liar
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name e4D New business
Business Name/Type:
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: 2 JE22 1- v e c �j 9-4 n-t- SA r
*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 ac c a o e best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed &L'(��. -�
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APPROV 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 l -c.
/3
Date
Zoning Official
Other Official Date
county of Amemarte mepartment or s;ommumty mevempin►ent.
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: Reviewer to complete the following:
Y // - - Square footage of Use: AAA vl.e- 4Wl ! %!Jt
Is 6sc& LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. 63F / N
Permitted as: i
Y /NN
Will there be food preparation? Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
- Dent. -FAX DATE - - - -- - - - - -- . _ 1_. - - -- - -- - --
Circle the one that applies
Is parcel on private well or c ter?
If private well, provide He lth Dep ent form.
Zoning review can not begin anti we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or ublic sewer.
Y/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Parking formula: / � b 7 �
Required spaces:
Y/N
Items to be verified in the field:
Sign permit.
Permit # 0//- — l 7 Inspector • Date:
Y / Notes:
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7....3...: +....nm..ln +o +hn fnlln�crinrt•
Viol ions:
Y/
If so, ist:
Proffers:
Y /C�
If so, List:
Variance:
O/N
If so, List: a q
SP's:
6S>lN
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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