HomeMy WebLinkAboutCLE201100061 Review Comments Zoning Clearance 2011-03-231011 M1' BPj &V
Application for Z®ni Clearance
- -- - - CLE -# - -
OFFICE USE 812- r�
Check # Date:'G
PLEASE REVIEW ALL 3 SHEETS
Receipt # Z 2 g b Staff: 'LOA t A
PARCEL INFORMATION /, �J �� �J�� j�
Vd - - o 5 A '
Tax leap and Parcel: tJ ll/ r `) '-/ �� % �yTS ring ilon►ng "l i ✓
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Parcel Owner: 13 Fr2 1,2e ltlfl & cS Q f
Parcel Address: / /' �� y��� �� ��( t ;— State Zip �G
(include suite or floor) `�e -
PRIMARY CONTACT ``pp
Who should we call /write concerning this project? Ytl � _ (Ecz..
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Address :100 ���,'rlHlacY:t l ! CC L City Ch Y(,i) y i UL State V A- Zip Z 0
Office Phone: ( — 014 4 Cell # Fax # E -mail fe (_ 1 g_ds e l:l&k(pv > ",
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name/Type: 0.`m °� C'.c c -Il/� L V-c- (2 w 2V-01 (I
Previous Business on this site \M \20-.-V2 �-i PTetc� z
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that ou can provide: t (
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\n o Sy � [ =A ts,
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*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 knowledge. I have read the conditions of approval, and I understand ahem, and that I will abide by them.
Signature Printed \Iosyt e V"-e reZ
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 (I ((
Zoning Official Date _7
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: I Reviewer to complete the following:
W
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/0
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 wel or public water?
If private well, provide e ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic or ublic sewer?
Y/(R)
Will you 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 #
Zoning to complete the followinLy:
10/ N �^
Permitted as: - G1��� (S-1
Under Section: /� M _ COD
Supplementary regulations section:
Parking formula: �/ v
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
0
Viola�ns:
Y / ,',L
If so, t:
— • ffers:
N
so, List:
�a lance:
Y�/�
feo List:
N
VS/0,
List:
Clearances:
SDP4��
Revised 1/1/2011 Page 3 of 3