HomeMy WebLinkAboutCLE201100097 Review Comments Zoning Clearance 2011-05-31of ai_w,
Application i ®r Zoning Clearance , r
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONI,Y I� f
Check # Date:
} Staff:
Receipt # Z S
PARCEL INFORMATIOv �j L1 (S/ /l �1l �b` �� Existing Zoning
Tax Map and Parcel: 4�
m f C+ 19NT/6'V,S' 1 f
Parcel Owner: 7J
16 1 �_ State Y ` Zip
Parcel Address:: I �i 1 `��� City
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?�_"C
Addre ss ii �� 2J f t��r � o tY QL02.1rit.. tate q A= Zip O,2
_Zy B04 E -mail
Office Phone: (mil # A d - 2
APPLICANT INFORMATION
Check any that apply: Change of ownership J4
Change of use Change of name _ New business
Business Name /Type:
Previous Business on this site 1 cx C` h
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 newpcation, 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 Ile, information provided
is true and accurate to the best f my imowledge. I have read the conditions of approval, and I understand them, and that I Neill abide by them.
Signature Printed
APPROVAL °INFORMATION
[ ] Denied
lef Approved as proposed [ ] Approved with conditions
[ ] 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
l
Building Official - Date
Zoning Official Date
Other Official Date
County of Albemarle impartment of L;ommum>Ly Veveiu}rneca,e
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 97Z -4126
Revised 1/1/2011 Page 2 of 3
Intake to complete the following:
Y �N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
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 applies
Is parcel on private well o pu�wa If private well, provide Hea form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl es
Is parcel on septic or is sew ?
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 #
ZoninLy to complete the followin6:
Reviewer to complete the following:
Square footage of Use: j) v
D/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
� W '
S / 17'
N
If so, List: ®� n
ffe
Pro :
Y N
If so, ist:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3