HomeMy WebLinkAboutCLE201100042 Review Comments Zoning Clearance 2011-03-03Application f ®r , onin Clearance
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CLE # --
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Zoning Clearance = $35
OFFICE USE O�1LQQ6 L6
Check # Date: G
EM
PLEAAY REVIEW ALL 3 SHEETS
Receipt # Staff: (J
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PARCEL INFORMATION , I t �," fi"
�j '' �� D Existing Zoning (l 1l•Jau
Tax Map and Parcel: ! l 11�1'%�,ayyLC
Parcel Owner: Uni VeYS i DP' VI IrA 1 rlt' a EO-'U(nd u h On
Parcel Address: J bwrs Py�a City. Ch4 C 14 d oftVI �.L State V Zip Z2
(include suite or floor)
PRIMARY CONTAC T
Who should we call /write concerning this project?
Address: 1-00-4s k�ec�a ��` U. City GvG-' \( \Jt1�P State .\J Zip 2Z�1o3
Office Phone: ( loll IZI 03to Cell # 91-x- k2[ N9 Fax# 66$ •4N -S'lY' 1 E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name )( New business
Business Name /Type: F�NRNC�RL S�(wi�zS}yE ��tvN W��STs/V�EN1 N��t��C-tEt^nCNI
Previous Business on this site 1J
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: �em,r,.Ncl ��Lt <PAte
*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 th t 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 e the best of my knowledge. 1 have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed MA"2 L SM l I1-+-
Ti vp, 'Fb
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 4 > l
Zoning Official Date �J
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 04/28/08, 10/13/09 Page 2 of 3
Intake to complete the following:
Y GN.
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wi sere 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 pub
If private well, provide Healt
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or ublic sewer.
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: 0 ��
Permitted as: UJl1t/` _
Under Section:
Supplementary regulations section:
Parking formula: 1 f 0 �
Required spaces: H
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
EXHIBIT "A" r
Attached to the Lease Agreement betwegn the UVA Foundation and Eric Kallen dated , d 2- 2010
PREMISES FLOOR PLAN
Suite E, 3 Boars Head Lane, 888 RSF
17
B,Z:ased 92Tb2L6:01 N9- nWN3B dH:W0JA 90:00 titi02- S2-88d