HomeMy WebLinkAboutCLE201000211 Review Comments Zoning Clearance 2010-10-15^Vz_rJC,
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Application for : onin Clearance
CLEW
�'ttm,Ntin
Zoning Clearance = a35
OFFICE USE ONLY
Checic # Date: S Il ,t
Receipt # Staff:
PLEA REVIEW ALL 3 SHEETS
- - PARCEL INFORMATION - -_ -- -- - -_ -
W r' — /4 Existing Zoning
Tax Map and Parcel: Y
Parcel Owner:
Address: /� �i Pbii% �Ni �ih' i! tl/ f State �t� ° Zip
Parcel
(include suite or floor)
PRIMARY CONTACT
/ '�
Who should we call /write concerning this project? i✓�rb d� –�
/.9 %li` ( City State _ Zip
Address: L n lJ —
i
Office Phone: (_, Cell #�Fd – ax # E -mai /4
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name 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:
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 spaceindicated on this application I also certify that the information provided
have the of approval, and I understand them, and that I will abide by them.
is true and accurate to the best of my know edge. I read conditions
–
Signature Printed �^ % F –
APPROVAL NFORMATION
�] Approved as proposed [ ] Approved with conditions [ ]Denied
17.
[ ] Backflow prevention device and/or current test data needed for this site, Contact ACSA, 977 -4511, xl
[ ] No site inspection has been done for this clearance, 'Therefore, it is not a determination of compliance with the existing
physical
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
p
Building Official �— Date
Zoning Official Date
Other- Official Date
Count), 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
Intake to complete the following:
Is us 'l Hl or PD1P zoning? if so, give applicant a Certified
Engineer's Report (CER) packet.
Y / I
- -will- . be- food_preparation — -- -__ -- -- - -__
If so, give applicant a 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 private well or pu is water
If private well, provide Health ep r ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or
Y/N
will you be putting up a new sign of any ldnd? If so, obtain proper
Sign permit,
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7,0ning to complete the follomtlg:
violations:
Y /7\
If so, List:
I
Variance:
Y Gl
If so, List:
Clearances:
46-
ci6--/
Reviewer to complete the I.0110wing:
Square footage of Use: 2`3.�'o
Prm tted as: �
Under Section: J., L`
Supplementary regulations section:
Parking formula: /
% J
Required spaces:
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Prof ers:
Y/
If so, ist:
SP's:
If so, List:
SDP's
,r Revised 04/28/08, 10/13/09 Page 3 of 3
I C