HomeMy WebLinkAboutCLE201100100 Review Comments Zoning Clearance 2011-05-24Application for Zoning Clearance
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Checic# ��� /S`y Date:
Receipt # f(Y- 71) Staff: jnwag
PARCEL INFORMATION
Zoning h
Tax Map and Parcel: Existing
ParcelOwner: VeOiV Cgtsw
M/1 AV 71- CC ii
Parcel Address: 15 City C'ftnuo IN)" JIL State
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? -bA&) c`). IM OA)L
Address: 150 Nl ea Do ubeob c W City .E Xa ,)-J� State - Zip Z2d 6 j
�VA
Office Phone: qL3) 2") /9 Cell # (703) I2%-2911 Fax #(3-YO)- E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
/
Business Name /Type: kk 46A(A)ST- D2.1765 c.- CHI,1L
Previous Business on this site VACA.Alf 20ILDO-M,
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: 'IE'V, i_-Q DC- (LASS "C" VI,e6r.Nt.1
AAOQOCU 6/&& O2k5 (-eorn 6 °23 THeu '7- oS Zoil .
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*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 t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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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 -j I d `t t i
Zoning Official /fi ' ;i Date�2� /%
Other Official- Date
r�'_e;s t:'(,� Z
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:
Is/
Is us m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /0
Will there 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 69e ater?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Reviewer to complete the following:
Square footage of Use:
X/N
Permitted as: LlGn ' �i'A��S
Under Section: Y-4 4;,' '
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Circle the one that applies,---------, Items to be verified in the field:
Is parcel on septic or pqn�-er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y / rl Notes:
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnin¢ to cmmnlete the fnllnwinu:
Violations:
() /N
If so, List: (� A I
Proff rs:
Y/Z
If so, ist:
Var . ce:
Y/e
If so, List:
SP's:
&N
If so, List:
7,6 l 6
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
SSTAND
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