HomeMy WebLinkAboutCLE201100024 Review Comments Zoning Clearance 2011-02-03Application for Zoning Clearance
CLE #
OFFICE USE O L
� � 02
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # 9 Staff:
PARCEL INFORMATION
V c
Tax Map and Parcel: l SL - -_J� _ _ CJ _Existing Zoning
Parcel Owner: V t!E:'e,S
Parcel Address: 1�t� S0.e�tw. Puce �S"'Fe� City Uf- State J/I Zip zz5ol
(include suite or floor)
PRIMARY CONTACT , p
1 4 v . Ct �eu-,e F
Who should we call /write concerning this proiect? yU
Address : I`\L� one W. m,_tt, < City State Zip ZZyo
Office .Phone: (`N�' Z-q A -001`1 Cell # rQ JA Fax # r- E -mail � m 7 b-i tV tj G CL- (j
LILN�vjL.1ua►L,NE 1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name /New business
Business Name /Type: Z- L-" q-t q. Li e . /'J('..
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: A �up.r��� �-c t , o e,., l° e - "s't- Sal' , car f-
e. Cllasle
aCe.r,� 1o1,J 0oCk 3 -5 )t'-'4 s wetAe ,n.°rWztovs 'U° l s
*This Clearance win 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 accura ny knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed YC��� 6 �" y. AV-w� t
APPROVAL INFORMATION
y]'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 ` r�.1 p °= =—�� 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 2 of 3
Intakke to complete the following:
Y / V
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /,
Will l'cre be food preparation?
if so give-app licant -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 pi c wat r?
If private well, provide Healt De > nent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or is se
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
"'Y / N
i' Will.there be any new construction or renovations?
If s'o', obtain the proper Permit.
Permit #
7nninff to emmnlete the fnllnwinu-
Reviewer to complete the following:
Square footage of Use: � JD
b/ N ,
Permitted as: 0
Under Section: ,2
Supplementary regulations section:
Parking formula:
Required spaces:
Y /'IN
Items be verified in the field:
Inspector : Date:
Notes:
Violations:
Y //
If so, 'mil ist:
Proff s:
Y //N
If so, ist:
Variance:
Y /—A)
If so,'Zist:
II S
SP's.
Y /A—
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
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