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HomeMy WebLinkAboutCLE201000210 Review Comments Zoning Clearance 2010-10-14Application for Zoning Clearanee CLE # 2 0 ID �RGIN�P Zoning Clearance = $35 OFFICE USE ONLY Check # Date: `b j Z`- v PLEASE REVIEW ALL 3 SHEETS Receipt # Z()G 3�C- Staff, - PARC- EL— INFORMA -T-ION _ ' Tax Map and Parcel: 15 - ^ - -2 O N Existing Zoning � Parcel Owner: ^1 t' ,, 54A45 L' Lifi i C� ,u , () s��t�- �� Parcel Address: 72� /'�� R city C114!'l G �� @ State Zip (include suite or floor) PRIMARY CONTACT �(� o� �� �j Who should we call /write concerning this project. r AddressS/ WO47-p't9aia /�aG1d City C�up�i�L`�State y� Zip2Z��� Office Phone: () y Cell E -mail `@• 46Y9atM� • o /�� APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name _ New business Business Name /Type:,AMe-Ar ^<fOt/✓ /✓16. 2 S! %✓S L`C V'•''i/YL :sr Business this Previous on 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: Vi"'�G Sir/✓✓ /��u��: �9� ���L �"� %� z 1 o'>ti' Put /L,,r9• S��.Ges, 1 ( /eti�'GGe_, *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 2 � �1r. -- Printed b'4, ©I✓ APPROVAL INFORMATION as proposed [ ] Approved with conditions [ ] Denied ]Approved Backflow prevention device and/or out 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 i o o a Zoning Official Date zo L Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902nVoice: (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: �?/ 6' Is u m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. 91 N Permitted as: bia n `11 Y C y WWII re be food preparation? Under Section: If so, give applicant a Health Department form. Z- oning- r- eview- can - not - begin - until= we- r- ecei -ve- approval- from= Healtli-- Supplementar _y_regulations_section. - - - Dept. FAX DATE Circle the one that applies Parking formula: Is parcel on private well or ublic ater? �I r y If private well, provide Health Department form. Oe Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Y/N Circle the one that applies Item o be verified in the field: Is parcel on septic or ublic se er? Y_/ N Will you be putting up a new sign of any land? If so, obtain proper Sign permit. j Permit # / F .S Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7.nnina to emmnlete the fnllnwinu- Inspector• Notes: Date: V' ns: Y /(T If so,\\ Proffers: Y/� If so, List: Var' nce: If so, t: SP's:�_l If so, List: Clearances: r/o —%10 SDP's Revised 04/28/08, 10/13/09 Page 3 of 3