HomeMy WebLinkAboutCLE201000225 Review Comments Zoning Clearance 2010-11-08Count), 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
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Application for Zozl j..9
'tttaiN�h
OFFICE E ONLY
❑ Zoning Clearance = $35
Check # Date:
PLEASE REVIE"4l ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Too -od - 00 -o bm Existing Zonin d'al9 -1 CA
Parcel Owner:
Parcel Address: �T _—f � ( City State Zip�Z��
(include suite or floor)
PRIMARY CONTACT 7 e
(` 171 C ��� `
Who should we call /write concerning this project? (L'
� 7% Cite F � fill k State k f U� Zip
Address: LJL� C
3� E -mail � S 1e
Office Phone: (_J �A Cell # �a� # P
APPLICANT INFORMATION
Check an), that apply: Change of ownership Change of use Change of name New business
Business Name/T, l� ype: cc Ar ' ®� 2 ,
A
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, av liable parking spaces, number of
vehicles, a d ant, additional information that you can ovide:
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*Tbls CleKrabce 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 l the owner's permission to use the spaceindicawd on this application. I also certify that the information provided
I have the conditions of approval, and I and that II will abide by them.
is true and accurate to b my kno edge. read understand
Jthem,
Signature i Printed 7G!/�—
APPROVAL INF TION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or cut•rent 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
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
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Intake to complete the following:
Y IG
Is use m Li, 141 or PDIP zoning? if so, give applicant a Certified
Engineer's Report (CER) packet..
} N
Wilere 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 r ublic water ?
If private well, provide Health epartment fonn.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a plies
is parcel on septic r public sewer:
Y/N
Will you be putting up a new sign of and, kind? If so, obtain proper
Sign permit.
Permit #
Y N
Veil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
coning to complete the follomt ng:
Vio Ions:
Y /l I
If so, List:
Varia e:
Y / r
If so, List:
Clearances:
Reviewer to complete the following:
Square footage of Use: ( d () J
- / 1� -
Permitted as: (( 4-A► r
Under Section:
Supplementary regulations section:
Parking formula:
.T )M
Required spaces: �V/3 J 1
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Proffe
Y/ '
If so, List:
S 's:
S' N
so, List:
c
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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