HomeMy WebLinkAboutCLE201100006 Review Comments Zoning Clearance 2011-01-12Application for Zoning Clearance
CLE# d6 //- (,
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 1 Z Date: 6 t
Receipt tf J Staff':
PARCEL INFORMATION �G r,
Tax Map and Parcel: ( 0 CL�� Existing Zoning 1 fv
Parcel Owner: e r 6
_Re
Parcel Address: 3g ?0 1 i C_h1110AJ Q City �PStd i C State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? \ /on- � Ci ` ✓� Z° �
Address: 3R-?( IR' C'►'? aw)d City l \L° SLcJ , C % State (/)q Zip �9y
Office Phone:) d 93 " ?76 ')CelI # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Y Change of name New business
Business Name /Type: _a ('U r �M�
/�
Previous Business on this site 1 ' r ' 11� e l - ��% rs &f o Se
Describe the proposed business including use, number of employees, number of shifts, available parking /ss� aces, number of
vehicles, and any additional information that you can provide: 3 e M Q /o q e (f s , , I S 6 , f—_/
*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 -to -the best -of knowledge.. -I have read- the - conditions of approval, and I understand them, and that I will abide by them.
//my
Signathu'e Printed
APPROVAL INFORMATION
[Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backllow prevention device and /or current test data needed for this site. Contact ACSA, 977-45 1 1, xl 17.
[ ] 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
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, 'VA 22902 Voice; (434) 296 -5832 Fax: (434) 972 4126
Revised 1/1/2011 Page 2of3
Intake to complete the following:
Y /O
Is use in Li, Hl or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /N
���il iere be food preparation?
Ifso, give applicant a health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a )lies
Is parcel on private well r public water?
If private we , provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel or septi or public sewer?
Y /(N)
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y IN
W ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin :
Reviewer to complete the following:
Square footage of Use:
P en ermitted as:
Under Section: Al �j✓ r) T dCt//�t/'��11J�
U o
Supplementary regulations section;
Parking formula:
m 0(\�"
Required spaces:
Y/
Iten • be verified in the field;
Inspector:
Notes:
Date:
Viola ns:
YS
If ,List;
Profi s:
Y/N
If so, ist;
Varia ce:
Y /
If so, List;
SP's
y / r
If List;
Clearances: J�
SDP's J�
Revised 1/1 /201 1 Page 3 of 3