HomeMy WebLinkAboutCLE201100052 Review Comments Zoning Clearance 2011-03-21Application for 2 onin. Clearance
CLE#
()FPICE (Is ON LY
PLEASE REVIEW ALL 3 SREETS i Check Date:
Receipt # Staff:
iPARCEL INFORMATION /�j %(�� C-7
Tax Y1ap and Parcel: 2 —^'/..is-tingzonin� /�l�j %� /et,
'Parcel Owner :5 L
Parcel Address: c f city 17x , zip
(incft de suite or floor)
PRIMARY CONTACT
Who should we call/write coneerning his pro' •t
Address: / 1 City �lL� �� / State �� • zip `Z1
Office Phone: ab X01 _l Fax i /F, �yy/ E-mail
' IV3 'k .z'7 O C) 713 i( l
I APPLICANT INFORMATION
Check any that apply: j�Change of ownership Change of use Change of name New business
Business Name/ Type:
Previous Business on this site
7 T
I I
! Describe the proposed business including use, number.of emplo ees, number of shirts, callable parking spaces, number of
vehicles, and any additional Information that you can provide:Q
This Clearance will only be valid on the parcel for which it is approved, If change, intensify ot• move the use to a new loe9tion, a new Zoning
Clearance will be required,
1 hcrcb} ccttif that 1 own or have the owner's pe . ' s' t� ° he space indicated on this application. I also ccrti.fy that the informefion, provided
is true and accurate to (ho best of my kno , ' ge. l ve the 00610ons of approval, and! undcrsta d- em /, and that Twill abide by them.
Signature Printed
I
APPROVAL INFORMATION
( ,, ApproYcd as proposed [ ] Approved with conditions [ '; Denied
j i3aekflow prevention device and /or current test data needed fat, this site. Contact ACSA, 977 -4511, x117.
[ j NO physical -site inspection has been done for'thit 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: 1
Building Official bate'
Zoning Official pate �_I
Other Official _ bate
County of Albemarle Department of Comntitnity Development '
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5$32 Fax: (434) 972 -4126
Revised 1/1/2011 Paget of3
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Intake to complete the following;
Y ;
Is use to Li, Hl or °DIP zoning? If so, give applicant a Certified
engineer's Repor, (CER) packet.
Y N
W.., there be food preparation?
if so, give applicant a l-lealth Department form.
Zoning revie%, can not begin until we receive approval from Health
Dept. PAX DATE
Circle the one that applies
Is parcel on private well o b ' r,
If private well, provide Idea th Department form.
Zoning review can not begin, until we receive approval from Health
Dept, PAX DATE
Circle the one that app lie
Is parcel on septic or(f6blic sower?
Y
Wi you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
W ere be anyncw construction or renovations? '
If so, obtain the proper Permit.
Permit #
Zoninff to complete tbp. fnitnwina!
Reviewer to Complete the following-
Square footage of Use:
Y0'IN r
Permitted as: V, J �"-A
Under Section:
Supplernegtary regulations section:
Parking fornnuia:
k �
Required spaces:
Y;
ltems o be verified in the field:
inspector:
Notes;
Date:
VYOia ions:
Y/�
Ifs ist:
i Pt-off S:
i'y/
If so, Lisf:
• 1
'VaVWI
Y
If so, List:
..
Y/9)
If so, List:
I
,
I j
1 Clearances: I
1 2 0 AO
Sl3P's
i
I
Revised 1/] /201 1 Page 3 o0
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