HomeMy WebLinkAboutCLE201100046 Review Comments Zoning Clearance 2011-03-08Application for Zoning learance
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CLE # �� - �� �
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 12 �}�/ Date:
Receipt # 9Z Z9 Staff:
PARCEL INFORMATION
Tax Map and Parcei: L)6p /uv '- yu -_//c U J//7_u_ _ _ _ Existing Zoning
�y
Parcel Owner: 6,e r1l�e, /� , r ,aKS r 13/y ,ev5
Parcel Address: 1666 Z- o �� �,_S�D. (5"16 City \�4ci�- Es State VA Zipo;a9,11
(include suite or floor)
PRIMARY CONTACT / p
Who should we call /write concerning this project?
7
Address : �� Z ee-)A 4e,19 Al, City (lC_ h T State Zip A616K
Office Phone: r%Z 7 72-52 eA Cell # Fax # 7,24y-774-4 �1 -mail Jerry e re ehtc/�i C'cy %�-j
APPLICANT INFORMATION le
Check any that apply: Change of ownership Change off use/ of name New. business
_
/C/hange
Business Name /Type:&ST /�l ✓�' ✓� �b'J, �('
Previous Business on this site
Describe the proposed business including use, number of employees number of shifts, available parking spaces, number of
information that Weal Ctd S"601 —e-
vehicles, and any additional you can provide: ✓'?A41F.1 a 26-4f
*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 accurate to the best of my owlYge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed ,.J e- i-✓'y `<e�:24C 2
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 g i
Zoning Official Date I 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 us� LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
Y /
ermitted as:
Will ere be food preparation?
Under Section:
If so, give applicant a Health Department forma
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 we or public water?
Parking formula:
SDP's
If private well, provide ent form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y N
Circle the one that ap
Item to be verified in the field:
Is parcel on septic r public sew r?
Y / �N
Will . u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / N
Will there be any new construction or renovatio
If so, obtain he proper Pe it.
Permit #
Notes:
s�VC YC 'O 7 �j s -e :--; 3,031
1
Zoning to comDlete the following:
Viol -tio s:
Y /'N
Ifs
Pr7,� :
Y
If t:
Var'ance:
Y N)
Ifs Est:
SP's•
Y /
If so, ist:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
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