HomeMy WebLinkAboutCLE201100092 Review Comments Zoning Clearance 2011-05-20I
Application for Zoning Clearance
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S� Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # C Staff:
PARCEL INFORiVIATIO gong Ill
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Tax iVla and Parcel: Existing Zoniu �
Parcel Owner: �Yi`N YVtC�1%�31t7N
Parcel Address: 1 /Vl� ��/ L11 Cit G State V R Zip
—�� lZ� Y �� Ili a' -2�d1
(include suite or floor)
PRIMARY CONTACT 4
Who should we call/write concerning this project? 1 ► � 1 t C�4A�jL�l�1(S�L�
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Address: ��S —Tn, ,.1i_I LA) �fl�� State �� Zip
Office Phone., (qi, '3` 1Y Cell# Pax# E- mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
0
41
Business Name/Type:
Previous Business on this site % l
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: GV�p 1/]o_ 2gV4 OL z`i1_'?�_
*This Clearance will only be valid on the parcel 17or which it is approved; If You change; intensity or move the use to a new location; a new 7_oning
Clearance will be required.
1 hereby certify th vn or have the owner's permission to use the space indicated on this application. [also certify that the information provided
is true and aeeu est of iuy luibivledge. I hiive read the eondittions of approval, acid I understand thein. and that I will abide by them.
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Signature Printed 1))��f� —�
APPROVAL RMATION
[ ] Approved as proposed [ �pproved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x 117.
] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
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[ ] This site complies with the site lan as of his date. Q� k
Y
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Notes: ����� 1—�� `� aE
Building Official Date J ( I
nn+�
Zoning Official 11b Date D`�
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
/L4 c
Intake to complete the following:
Y /'i
Is use in LI, HI or PDIP zoning? If so; give applicant a Certified
Engineer's Report (CER) packet.
Y /
LVill sere 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 1-leaith Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap lies
is parcel on Septic or puUlie sewer?
Y
Wil you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y / N
GVill tere be any new construction or renovations?
If so, obtain the proper Permit.
Perenit #
Zoning to comDlete the following:
Reviewer to complete the following:
ware footage of Use: 6 0 �- �( SS
errriitted as: t hk(MA'Ak
Under Section: Vd • - '�
Supplementary regulations section:
Parking formula:
U
Required spaces'
Y/N
Item be verifie in the field:
,Inspector:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
YIN
If so, List:
Cleiriiiices: �• n t^�� � i (Y ^i
SDP's
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Tax Map:
Scale
Albemarle County 061 M Part 1
0 210 420 630
Jf tr Feet Berkeley Community
Note: This map is for display purposes only
and shows parcels asof12 V2009. , J
�l�✓ See Map Book introduction for additional details. - ...,
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