HomeMy WebLinkAboutCLE201100023 Review Comments Zoning Clearance 2011-02-14inin�
Application f®r Cle arance
CLE �
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE I _
Check # Date:
Receipt # v 9 Staff:
PARCEL INFORMATION
Tax Map and Parcel: !C/' '' �l�lJ' " v `- Existing Zoning
Parcel Owner. t IJ r, eft �P_ /l Cle h. 0,-\
Parcel Address City A eSl) CState I, A . Zip O)
(include suitelor floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 11)
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Address: Cityarlrklle.5vs, Mate Z6p
Office Phone: ' ' L - dj 7 q Cell #_ 7 �� - 0`S �J Fax # E -mail I Uila C),frrr4 14 q an o) tl( om
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Oi r+� �n^�rt S
, )�. �' Ly ro<Z `'t lT 6�dC�, r\01
Previous Business on this site a r 4 \.A �(q S c°_, I L- Se ro e -t G (rUArrti r.gy
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Describe the proposed business including use, number of emplo ees, number of shifts, available parking spaces, number of
11;-- b-u 'Re
vehicles, and any additiottnal information that you can provide: n(2,1 Seine I1 f o %(' e-
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*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 cc rate to the best of my knowledge. I have read the conditions of approval, and I understand them, and th t I will Qabide by them.
Sig nat,re d Printed CQ 0012 Gle i
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 ]`� 14 I ( I
Zoning Official Date / 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 1/1/2011 Page 2 of 3
Intake to complete the following: Reviewer to complete the following:
Y /� Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified -
Engineer's Report (CER) packet. Y / N
Permitted as:
Y /
Will ere be food preparation? Under Section: _.
If so; give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well ..r_P_ah ic_w-atep
If private well, 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 on septic or
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followinLy:
Parking formula:
Required spaces:
Y
lte to be verified in the field:
Inspector:
Notes:
Date:
Violations:
&/N
If so, List: n
Prof rs:
Y /0l
If so, List:
Variance:
Y /
If so, ist:
Y
SPYList:
If
Clearances: 2
SDP's
Revised 1/1/2011 Page 3 of 3
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