HomeMy WebLinkAboutCLE201100001 Review Comments Zoning Clearance 2011-04-05- -
Application - fop - Zoning- Cle- ar-ance - -/-�- -T-
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OFFICE US LY
PLEASE REVIEW ALL 3 SHEETS
Check# Date: -
Receipt # Staff:
PARCEL INFORMATION
Tax Map and P cel: ��' Existing Zoning
-jAAParcel Owner:
NiXe— 'A
Parcel Address: City State Zip
(include suite or floor)
PRIMARY CONTACT ) ) J
pan 15 �rC�i
Who should we call/write concerning this project? rin'l 1'e tecT
Address: alyS 5✓i% 3v/ City State Zip 55116
Office Phone: G( S/) ¢,10 SS25 Cell # Fax #.X51- 4/10 - ssy5 E -mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership of use Change of name New business
/I'Change
Business Name /Type: /-< ScpII,��4�s c� 64'r'r1o17a5yi'IV- 64341'nn Sg�n�� +,� C�u�o�o�tsyrl/e, f/.9' ��4c �
Previous Business on this site 1/G cowT
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: �d5 �%r c �rc JQ %.
*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 accur to to of my k nowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatu Printed , i 'Lpp,®l t� l i( AC4W 05p1+�-,
APPROVAL TION
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 -� Q . - — �-c-�. Date i
Zoning Official ?7 Date (�
a
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 2 of 3
303
_______Intake
to complete_ the_following:___ _,__
_Rev_iewer to complete the fogl�lowing: _ _
Y /M
Square footage of Use: b� /
Is u in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /(N
Will there be food preparation?
/ N L
Oermitted as:
Under Section: �_5 2 I
If so, give applicant,a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Clearances:
SDP's
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o ublie w er?
Parking formula:
If private well, provide Heal apartment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/
Circle the one that ap
Items o be verified in the field:
Is parcel on septic public sew
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # -2—z> 1 P 291 /1 C'
Znnina to emmnlete the fnllnwinuc
Violations:
/N
f so, List: � 1 �
Proffers:
If/
If so',`cist:
Vari ce:
Y/
If so, ist:
SP's: -
Y/ 1
If so, st:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
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