Loading...
HomeMy WebLinkAboutCLE201000250 Review Comments Zoning Clearance 2010-12-30Applicati ®n for ZoninLy Clearance CLE � ----- ---- -- - -- — - --_.. ----- - -- - -- Zoning Clearance = $35 PLEA. + REVIEW ALL 3 SHEETS //UIltCIN�P OFFICE USE- NUY ----- — --/ -- - � --- -- Check # Date: - I U Receipt # Staff: -PARCEL INFORMATION -�% —_ _ - -/r --- ---- Tax Map and Parcel: / G E' xisting Zoning Parcel Owner: VI `� Parcel Address: `7 ©� �� 0 ITiLI &rfl-City G %11112Ld -rj� 01-96te Zip 7- (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address: ') jj G (,40P ly A- City r,A 2 V) I- L.45- State VA Zip -29 Office Phone: (� / �`D� CeII #� 1, 6g'l�' Fax # Z& � 77Z E -mail 6 (220r+'/% G APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: U Pi (/,,"!917 -C1 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: �� % ��"� i=�r *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 t ie best of my knowledge. I have read the conditions of approval; and I understand them, and that +I ,will abide by them. Signature G��/! �l ���J /% �L�� Printed LIP-Alul4 .-1 ev 4 . at Cl�� 2d l APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied ] Bacicflow prevention device and /or current 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 `' c A Date Zoning Official ✓` Date 7 -13J// /) Other Official Date County of Albemarle Department: of Community veve►opment 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 i Y f I- Intake to complete the following: Reviewer to complete the following: Y / Square footage of Use: _/ 9 Is use`rfi Li, H1 or PDIP zoning? If so, give applicant a Certified � Engineer's Report (CER) packet. N _._ -- - -- - - - - Permitted. as: -- .DrA - Y/ i Will t sere be food preparation? Under Section: Z �1 if so, give applicant a- Health Department fonn. Zoning- review can -not begin until-we-receive approval from Health - Supplementary- regulations section: -- -- -- Dept. PAX DATE Circle the one that applies Parking tonnula: CC Is parcel on private well or er? If private well, provide Heal artment form. Zoning review can not begin until we receive approval fi•om Health Required spaces: Dept, FAX DATE Y/ Circle the one that ap Items to be verified in the field: Is parcel on septic o public se Y/N Will you be putting up a new sign of any ]rind? If so, obtain proper Sign pen-nit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Inspector : Date: Notes: uv uaai - Violations: &/Nr :Jf so, List: II n ffers: /N f so, List: ariar ce: / ( so, List: J ' y D `( l SP's: Y /(9 If so, List: Clearances: SDP's Revised 04/28/08, 10/13/09 Page 3 of 3 Sep 24 05 12s36p. .J h O �Z �Q 2 V 7. �. V it p.2 .AL ZO /Z0 39dd dOHS 3IOG103dS VL666060t6 ZZ =9L OTOZ /bI /ZZ