HomeMy WebLinkAboutCLE201000219 Review Comments Zoning Clearance 2010-11-08` -- -Nov.- 8.-2010-- 11:25AM - Mattress - Warehous- e -30 -1 -831- 4672 -- - --
.Application for Zonin g Pearance
CLE # 1
�. �N -
OFFICE USE ONLY
Zoning Clearance = $35 Check # Uc Date: I o
Receipt # staff:
PLJ} REvXE'W ALL 3 S11EETS
PARCEL IN r ORMATZU rrII,, (( _nn �%�
b:xisting Zouinp `'`-
Tax Map and Parcel:l�
, I
Parcel Owner: rr '4 Filyd 1 c,4 i
1 '
Parcel Address: 1_` W -ern iy1A l it i rk I City Cif '�riB•� Lrt i'ty— State r� Zip
(include suite or floor)
PRIMARY CONTACT /
this
Who should we call /write coaceruiug project.
G
Address #ate f' Zlp
Office Phone: Fax # ���F��/ ��17m 1 •� �f�t�i�.[�@•C? %%a' Q�if .
S��LS
AP)PLIC:ANT EUORMA'11ON
Check any that apply: CCjhangc of ownership C�hyange of test of name New business
�ChAnge
r�
.
Previous Business on this site
Describe the proposed business including use, number of employees, n tuber of shlft�, available parking paces, number of
vehicles, and any additional information (hat you can provide:
"This Clearance will only he valid on the parcel for which it is approved. ifyou cbangc, intensify or move the usb io a new location, a new Zoning
Clcumnce will be required.
Thereby ccn* that 1 o ur have the owner's permission to use the space indicated on this application. I also certify that flit informution provided
is tare anti accurate to best of rossy kno , I have read Cho condidow of approval, and I uodcrsrand them, and that I will abide by them. .
Signature
l' "C. ._ •r'�7 Ets
APPROVAL INEORMA.TION
[ ] Approved as proposed [ ] Approved with conditions [ ] Dcnicd
[ ] Back -flow prevention dcvicc and/or cun-cnt test data needed for this site, Contact ACSA, 977- 4511., x 117,
[ ] No physical site inspection has been done far this clearance.. Thcrcforo, it is not a dctcxmina.tion of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date,.
Notes:
Building Official Date
7oniu>Ig Official . !Date -mil
Other Official Date
I -OUnLy 01 ArUenrarre uepanuree"► o" ,vv- 'F........
401 McIntire Road Charlottesville, VA 22902 Voice. (434) 296 -5832 Fax: (434) 972 -4126
Reviscd 04/28/08,10/13/09 Page 2 of 3
N o v- -8.2 0 -10- - 1 -1 . -2-6 AM -- -M a t-t -r e s s- W a r e h o u -s -e— 3 01-- 8 31 -- 4 6 7-2 - -- -- -- -N o_ 8 8 3 -5— - -P _3-
- Intake to complete the following; - - - - -- - Reviewer to complete the - following; - -- - - -- - -- - -- --
Y / Square footage of Usu; W U Q, irj L1
Ts use in LI, HI ur PDJP ?zoning? Tf so, give applicant a. Certified
Engineer's Report (CP.R) packet. / N
- 'Permitted as:. % f ;
X /
Will rEere be food preparation? Under Section-
if so, give applicant a Health Department form.
Zoning review cannot begin - until -we receive approval from Hcallh - Supplementary regulations - secfion;_ -
>F X DATE
Dept. A
offers:
f so, List;
Circle the one that apples
Parking formular
Ts parccl on priv�Yte well r public w er?
Tf private well, provide l le h De neat 1'onn.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept, FAX DATE
SP's:
C> N
If so, List•.
X/N
Circle the one that applies
Ts parcel on sept' or publics
Items to be verified in the field:
9/ N
Will you be putting up a new sign of any kind? If so, obtain proper
SDP's
Sign permit., )
Permit 11 ?-D i•b
inspector ; Date,
/ N
Notes:
Will there be any new construction or renovarions?
Tf so, obtain the proper Permit..
Permit #
7n�inn to nn"I"Intn thn fnlli%wina•
Viul 'ons:
X /IN
If so, ist:,
offers:
f so, List;
Variance;
Y A
If , ,ist:.
SP's:
C> N
If so, List•.
Clearances;_
SDP's
Rovised 04/28/08., 10/13/09 Page 3 of 3