HomeMy WebLinkAboutCLE201100034 Review Comments Zoning ClearanceApplication for Zoning Clearance
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CLE # �% /
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OFFICE USE ON L
2( ( 91090/1
PLEASE REVIEW ALL 3 SHEETS
Check# Date:
Receipt # � Staff:
PARCEL INFORMATION /y
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Tax reap Parcel: — "' ' Existing Zoning i21
and y J� 1-t /_ V V yy v�v�y tf}Yyj e f
Parcel Owner: }) �► (' 1'YJOYIGi, �) ,
Parcel Address: 8282 IU & d City larrloAe-5ul State VA Zip 2903
(include uite or floor)
PRIMARY CONTACT
&41& 13'eWtI,C/ Bn(C
Who should we call/write concerning this project? KOhin �
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Address : 227i J...�i KUC�QI City 010 I 1�1 - State V A Zip 903
Office Phone: Cell # Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 1 4 fljh CQ -7Qr7) U C-
,
Previous Business on this site c 'LZ��1��Y -1�,� g�
Describe the proposed business including use, number of emplo es, number of shifts, available parking spaces, number o
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vehicles, and any additional information that you can provide: ��2s : 11
ta ) : �2
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*"nits Clearance ill only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 y know le . have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed ��P �n`b �r- (�-t ei1�i Q (�,
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 i
VA e-i
'71 a 19
Zoning Official Date
Other Official Date
County of Albemarle Department of Community mvelopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 1/1/2011 Page 2 of 3
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Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use:. (/1
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
- D
Will er / be food preparation?
ermitted as �_]� o CYl i
Under Section: OM. ai .
If so, give applicant a Health Department form.
Zoning review cannot begin until we receive approval from Health -
_Sup ementary regulations section: - -,
Dept. FAX DATE
Va riance:
Y/N
If so, List:
Circle the one that applies
Is parcel on private well or public water?
Parking formula: ((SS I r�a�� ����� ��
Ace I �
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Is parcel on septic or public sewer?
tems to be verified in the field:
Clearances: ,
�YN
SDP's
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. O
Permit # �b O��� r l c
Inspector d al&Date:
Y n
Will here be any new construction or renovations?
Notes:
I S
If so, obtain the proper Permit. .
Permit #
7nninv to emmnh -h- the fnllnwinu:
i lations:
Y N
VSO, List: � V/
Pro
Y oZ,
If sst:
Va riance:
Y/N
If so, List:
SP's•
Y/N
If so, ist:
Clearances: ,
wofy�
SDP's
at) to - '3 e-1
Revised 1/1/2011 Page 3 of 3
Route 250
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