HomeMy WebLinkAboutCLE201100068 Review Comments Zoning Clearance 2011-04-04Application for Zoning Clearance
CLE # ZO 11- Q
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 3,31-?f- Date:
Receipt # Staff: JOWrat
PARCEL INFORMATION jQ P
Tax Map and Parcel: ° / % Existing Zoning y�
Parcel Owner: %
l�/ /f/State 1��' ZipZ47
Parcel Address: City _LMIY�
(include suite or floor)
PRIMARY CONTACT C/ n
Who should we call /write concerning this project? l cal tip/ r M
l Doc) rn >;f v�Q 0013
Address : ( Doc iR Q S t� � i� City arI45,fj Y e State U Zip 2Z
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Office Phone: - �y(7 r2 Cell # (43Q) 227 - QaFax # E -mail Ct,CffVl11n i� Sd s -CA , CO 1/1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
36L(6 2,n�bet-mm r � 446 V "S C l,
'
Business Name /Type: C/
el
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.
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 e be t 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
[ ] 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
Zoning Official ` Date
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/l/2011 Page 2 of 3
I
Intake to complete the following:
Y us XI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /n/
Will e 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 well or public water?
If private well, provide
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic o er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there 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:
Y/N
Permitted as:'�
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: `--
Y -N
Items to be verified in the field:
Inspector : Date:
Notes:
Viol ns:
Y/
If so, List:
Proffers:
( Y /N
l�so, List:
Varian e:
Y / 7
If so, List:
SP's:
Y /
If so, List:
Clearances: ......
SDP's
Revised 1/1/2011 Page 3 of 3