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HomeMy WebLinkAboutCLE201100004 Review Comments Zoning Clearance 2011-01-24Application for Zon`ng Clearance ' °`° CLE # 20 � " '� x >P ���RGtN�P Zoning'Clearance = $35 OFFICE US � ONLY Check # Date: PLEA REVIEW ALL 3 SHEETS Receipt # -1 I Staff: PARCEL INFORMATION Tax Map and Parcel: aro(Oo — —D1(�- —' k23PI —Existing Zoning �l rrro.., l E4:z4 11C.V�/► " Parcel Owner: unt u Gr A I• W Ke t &a k Parcel Address: 176p Ac m,.hJe. SA 203 City Cl- weltllsolle- State VA Zipz7_161 (include suite or floor) PRIMARY CONTACT '' // Who should we call/write concerning this project? �,M %� Address: S. Covy '; t,, &ILA City F ► State Zip2_z&a5/_ Office Phone: Lo (8— Cell # Fax # o 04-bodl E -mail (Cv�t�f��t ti+eirwC� n+.�► APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business � 1 Business Name /Type: `G T'G.�l, 4_ L�r 1"i ryvt,?� / 1�'Sa1 Sc! ✓ILGS Previous Business on this site Describe the proposed business including use, number of em to ees vtuber of shifts available parking spaces, nu ber of vehicles, and an additional information that you can provide:.L&w t,nr►& Serr.%s QA4_1 - &6 2T e 4 14e...", 4-+ 4--k *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 accu o the best of my knowl -h averead.th%conditions of approval, and I understand them, and that Iwill abide by them. � � �°�''� 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, 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 1(d(( t( � J Zoning Official Date /12-V / 1, I Other Official Date County 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: Y/ ]& Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Will there 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 p I Pepartmertform. ? If private well, provide Health Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or, lic se . Y N Vl] you be putting up a new sign of any kind? If so, obtain proper Sign permi Permit # JA Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: ' ©'1 5 /N emitted as: Under Section: y—� .2 Supplementary regulations section: Parking formula: ! Required spaces: Y/N Items o be verified in the field: Inspector : Date: Notes: Viol io Y / 7 Ifs ,Dist: / Pr ff�r If If so, ist: Variance: Y If Oist: YY /N If so, List: JJ.. Clearances: SDP's Revised 04/28/08, 10/13/09 Page 3 of 3 'WO - °• r� 3 m rn '1O (D m Q : CO (D Q` p 7 C. O� CND p 0 ti 0 Q � X Q CD Q y C .:F �D N O -W co V Vr ^f7 D m 0 UJ N (� n (p D m N C N 0 0 m (R m N 0 0. 0 co 00 N C� C t