HomeMy WebLinkAboutCLE201100037 Review Comments Zoning Clearance 2011-02-25Application for Zoning Clearance
CLE 61
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ON1�Y
Check # ` b 1 Date: /�/�' 'i✓
Receipt # 1 c�'(i Staff:
PARCEL INFORMATION �-�^� nY1ilf A, J; 11A,1 I,.,,, ST ern :.a ✓ i
Tax Map and Parcel: r . �,,/ ] v �'`C"') Us^ ;/e 1 g 6 Y 4�isting Zoning I r(
Parcel Owner: o ( ` _e '� " S..�c/ua e
Parcel Address: 0?v ANi /e4P 4�'i`' i yCh4rJa pre✓ 61 Me— state Zip
Sul-4 4 (include suite or floor)
PRIMARY CONTACT
W!io should we call /write c✓aficerning this project? C{
/ A
Address :�D � / s I City State V 4- Zip
Office Plione: 4 9,13 ell # Fax # E -maiIC _ ./GLnw� Q6
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Chan a of name New business
Business Name /Type: 0AA4_s b aim 6- SQ /on
Previous Business on this site / ()% t Sh LJJ d4' 1 y L_ p/.CA--•
Describe the proposed business including use, number of employe��e� number of shifts, avails a parkin s}�aces, number of
jiicle ,�a any a ditiona information that you can provide: j�yQ t / S°� -CAM. I V
*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 percussion to use the space indicated on this application. I also certify that the information provided
is true and acc ate to the best of jPIcnowledge. have rea4 the conditions of approval, and I understand them, 94liat I will abide by tl em.
S ` Q�
ignatur Printed
AP P ROVAL 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 ?J 3
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
l�+ll<�l
Intake to complete the following:
Y /(!9
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / 6
Will there be food preparation?
If so, give applicant 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 o )—ub is water?
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 public sewer?
Y /
Wil i 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 #
'nnincr to emmrilete the fnllnwin¢:
Reviewer to complete the following:
Square footage of Use:
6Y /N
Permitted as: '14A
Under Section:) A. `
Supplementary regulations section:
Parking formula: D�
Required spaces:
Y /(NJ
Items o be verified in the field:
Inspector : Date:
Notes:
Violations:
/N
If�so, List:
r offers:
9/N
If so, List:
Varia ce:
Y /N0
If so, List:
SP's:
Ylb
If so, List:
• Clearances:
SDP's
i
a
i
Revised 1/1/2011 Page 3 of 3
?il-
516oi e- W&L
Ak
o 4
pov
&j ivikili