HomeMy WebLinkAboutCLE201100081 Review Comments Zoning ClearanceApplication for Zoning Clearance
PLEASE REVIEW ALL 3 SLEETS
OFFICE USE
1,6 Y
Check Date: 1 I
Receipt # Staff:
PARCEL INFORMATION r•
Tax Map and Parcel: 06 PV 0 r 02— 60 S�O Existing Zoning
ptZ
Parcel Owner: I _CI eL L o -Q vz_4L -eS
Parcel Address:. /o C A90 City44.61- le -a'us j/e State VA Zipzzlo/
(include suite or floor)
PRIMARY CONTACT C
Who should we caIl /write concerning this project? „� .l ✓� r�rG L
Address: � City A u K 4 ff --d, s%lt State VA Zip 22'701
Office Phone: (Z36 Zy CeII # Fax # E -mail
APPLICANT INFORMA ION
Check any that apply: V Change of ownership Change of use Change of name New business
Business Name /Typ : ,' 1
Previous Business on this site r y /'rte i N
Describe the proposed business including use, number of employ 9l, number of shifts, available parking spaces, number of
Z
��
vehicles, and any additional information that you can provide: /�c..c e�aC—Vt- Sd'� c-.
3L / 4 v1
*This Clearance will only be valid on the parcel for which it is approved. If you chancre, intensify or move the use to a new location, a new Zoning
r
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, an/d'I understand them, and that I will abide by them.
Signature c-� � Printed z 'I- r✓
INFORMATION
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -45 11, 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 l 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 1/1/2011 Page 2 of 3
Intake to complete the following:
Y G)
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wiptere 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 ublic water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or (public sewer?
Y/ NT
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y eq
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7.nnina fn rmmniPfP fha fnllnwina-
Reviewer to complete the following:
Square footage of Use: () p
A
Permitted as: ke--14,-4? > j
Under Section:�•� f
Supplementary regulations section:
Parking formula:�
a
Required spaces:
Y/N /
Items to be verified in the field:
Inspector : Date:
Notes:
viola ons:
Y /
If so, List:
Proffers:
Y /
If so, List:
Variance:
Y /q1N
If so st:
SP's:"
Y
Ifs st:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
Fk�
blf
i