HomeMy WebLinkAboutCLE201100062 Review Comments Zoning Clearance 2011-03-23Applicati ®n f ®r Zoning Clearance
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CLE # O — �.I J
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OFFICE ONLY 77
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PLEASE REVIEW ALL 3 SHEETS
Date:
Check# 01
R5 ipt # 3 Ing Staff: "J. YWJj-kfl
PARCEL INFORMATIO . Wig
Tax Map and P •cel: Existing Zonings v U
Parcel Owner:
Parcel Address: l�Cl l l �_Nall4�� City. State ' Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? .
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� Ja" Cit `Vti 1 State VA Zip
Address :ate _
Office Phone: (_) Cell - # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: /��—y ir✓ 11 ��r_ D
Previous Business on this site
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:
*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.
1 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 Printed
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backllow prevention device and /or current test data needed for this site. Contact ACSA, 977-4511, x] 17.
[ ] 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
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Zoning Official Date fZ,�% /�
Other Official Date
County ol'Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 1/1/201 1 Page 2 of'3
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Intake to complete the following: Reviewer to complete the following:
Y rN Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. Y / N
/ Permitted as;
Y �NQ
Will there be food preparation? Under Section:
I I'so, give applicant a Health Department form_ .
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 well o lie w er?
Parking formula:
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval fi•om Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Is parcel on septic or u lic se r?
Items to be verified in the field:
Y / N
Will you be pu g up a new sign of any kind? If so, obtain proper
Sign permit, UL
Permit # a
Inspector : Date:
Y / N
I
Notes:
Will there be any new construction or renovations?
If so, obt ' i t e ro er •tT
Permit # M
Znninu to comnlete the followin¢:
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 1/1/2011 Page 3 of*3
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