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HomeMy WebLinkAboutCLE201100101 Review Comments Zoning Clearance 2011-05-24Application for Zoning Clearance CLE # 201 � LO t OFFICE US O LY PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt# Staff: YY1iCQ�J PARCEL INFORMATION , , _n (� CLW Z Z Tax Map and Parcel: Aft Existing Zoning Parcel Owner: l 0 0 1— L 19161, -- -It J3 eS a 150 SO VA Parcel Address: f0 , _4 City rjO State Zip2��� (include suite or floor) PRIMARY CONTACT f Who should we call /write concerning this project? f Address: � cJ��Dil City 1 1,lP il/1 Lt �� State Zip ©r Office Phone: b Cell # DO °Z -�0 q-6 q-6 Fax # :79/Z E -mail iC 4� T7oL�/ �('� 0-0/ `Y APPLICANT INFO Check any that apply(--Y.- Change of ownership Change of use Change of name New business c Business Name /Type: Q j Previous Business on this site I S �i) `r� �✓i. Describe the proposed business including use, number of employees, number of shifts, available parking s, iaces, number of vehicles, an"ny additional information,tbaf you can provide: j)A k-0- .%%7 V-7 Q �'S S—h) 1 S, *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 the best of m mowleag I h ve read the conditions of approval, and I understand them, and than will abide by them. fI 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 1/1/2011 Page 2 of 3 A Intake to complete the following: Is us`e�in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / I Will ere 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 ap p lies Is parcel on private e1C wr :pu:biic w er? If private well, provide Hea artment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appl -i Is parcel on septic pu lic_se_ ? 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 # Zonin2 to complete the following: Reviewer to complete the following: Square footage of Use: P / Nmitted as: 41-1 N d Under Section: �1• I- Supplementary regulations section: Parking formula: Required spaces: Y Items to be verified in the field: Inspector: Notes: Date: Violations: l/N If so, List: � / Prof-fors: Y/ If so, List: Varia��f Y/V If so, List: SP's: Y/ If so, List: Clearances: SDP's Revised 1/1/2011 Page 3 of 3 c!) Lu H 0 o co) cy Z- (1) -1 1, od Z IrW- .1 oar I- OW , w CD, L) 40 ca 0 31 rr LU CC U- C\l T- U- co V- LCA v L) w U- 0 0 x