HomeMy WebLinkAboutCLE201000222 Review Comments Zoning Clearance 2010-11-05Application for Zoni-ng Gear.ance
CLE # M10 —
OFFICE USE ONLY
J&-oning Clearance = $35 Check # =� Date:
PLEASE REVIE�'4' ALL 3 SHEETS Receipt # Staff:
PARCEL INFORMATION _ --
Tax Map and Parcel: 1 0 G Existing ZoningM
Parcel Owner: '
ZZj`� n� S1 Ica City State AN Z1pZ2_ J
Parcel Address:
. (include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? �����
'l ✓r1 �JiL7L i�+� City ef NkNgLl.J T ;Wm Ll: State `f-f-t 4,21 4 Zip ZZ�ia
Address:-72,1'-L.
Office Phone: L _ Caw 40'(-4U(- Fax # E -mail ��' 1���s �� Z`{�J►��.t, c• ►+�
APPLICANT INFORMATION '
Check any that apply: Change of ownership Change of use Change of name New business
BusinessNamelType: i3\ "C_
Previous Business on this
Describe the proposed business including use, number of employe s, number qf shifts, available parking spaces, number of
vehicles, and any adVional+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 J own or have the owner's permission to use the spaceindicated on this application. I also certify 4t the information provided
is true and accurate to the best of njy know) dge. I have read the conditions of approval, and I understand them, and that will abide by them.
�` %,2✓ _
Signature,- ` — Printed
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, x:117.
[ ] 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 ( 1
Zoning Official Cf,•✓ Date J��
.. Rj
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: —Fik-e—viewer to coinplete the following:
\'; In, Square footage of Use: I
1' and a Certified
is use in Ll, HI or J-Dir zoning. 11 SO, give
Engineer's Report (CER) packet.
Permitted as:
wi0jerebo food -preparation? Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until \ye receive approval from Health Supplementary rec., gUlations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well oi� k—watel'9
i�i"' �ter9
If private well, provide Health Department forin.
Zoning revie", can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic ;au �ficsewer?
Y / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit,
Permit #
Y
Wi0lere be any new construction or renovations?
If so, obtain the proper Permit.
Permit # —
zoning to complete the follomlincl:
Violations;
OIN
If so, List:
Vart nee:
Y /
If sok,ist:
Clearances:
..... ..... .....
Parking form Ll I a:
Required spaces:
Ite be verified in the field:
Inspector: Date.
Notes:
Prof s:
Y
If so, List:
9/N ,S:
If so, List:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3