HomeMy WebLinkAboutCLE201100051 Review Comments Zoning Clearance 2011-03-21far
Application for Zoning Clearance
0
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # J,5-z, Date:
Receipt # =0-'Z,3 j Staff:
PARCEL INFORMATION
� �U7 " i�Tax Map and Parcel: 0 (2,1 Existing Zoning
Parcel Owner: l =-2/71I 0-C, I' C).00� '73ay Ch�4rjdi6SVl* V'14 adw'
Parcel Address: aaj� ,:—VLj aR #109- City C�1GIVlIIlkwlLState VOL Zip6),go3
(include or floor)
PRIMARY CONTACT _
Who should we call /write concerning this project?
ldress : 3 to 'tG>JI`n /�US Ville a state
Office Phone: 1U 15Cell # &I ' 3 ax # E -mail ' Vn .I
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site ( j'(�(� . (� 1=�— j bO'f7
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
informatio �-dzte — GiOUi'1'Y
vehicles, and any additional that you can provide: oial/f Gtlfae 7 1' ero:I
,_
('
*'Phis 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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature D4141 Printed �—) L ►N U"-)
APPROVAIVNtORMATION
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 3 I (1 C f
Zoning Official
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:
Y / I
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will Mere 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 welll or ubIf private well, provide Healt meet form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applied
Is parcel on septic or p6blic sewer?
\��
Y7JJN
Will you be putting up a new sign of any kind? If so, obtain proper
P gn per it. +)(o h T-eC h 5r'�n5 l� hci lJin�
Y /
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: __ 9 0-�-
&> /N
Permitted as: v- e+, ► I
Under Section L 5-, Z
Supplementary regulations section:
Parking formula:
�J
Required spaces: ¢
Y/ /.
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
ON
If so, List:
4G`1
Pro ers:
Y/�
If so, ist:
Varian ce:
Y /i
If so, List:
S 's:
V/N
If so, List:
Clearances:
✓�-� Gov
SDP's
Revised 1/1/2011 Page 3 of 3
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