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HomeMy WebLinkAboutCLE201100116 Review Comments Zoning Clearance 2011-06-28Application for Zoning Clearance CLE # 2 L I- I i (0 PLEASE REVIEW ALL 3 SHEETS OFFICE US O Y Check# Date: 10- -( Receipt # Staff- PARCEL INFORMATION i1 Tax Map and Parcel: ,Jqpiz� — 00 - (3C> -- ©Q/4R o Existing Zoning Parcel Owner:,40zy- h k� ►� P � � i C-U -- Parcel Address: CityOl AbV 1 l Mate Q-, Zip) G\ � ii 1 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? J C� �^C T�b �`��9 ►� ;1 � 1� lr(�C �, t (.( j Address: - ,C�, off., G-ng CityCU \C.ArjAQSxA jU State O,, Zi - 10(, Office Phone: Cell # Fax 44:3 - V�34- 5'16 E -mail 1! ^ jS41 Q ( oar, k sS i cn5, APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business \& Business Name /TypeAiiii C��I1 Q 'C" C7"Y"6 Previous Business on this site C 0 M M'0Y) ya C& - , l� Describe the proposed business including use, number of employees, numb e of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: P\QkO X S 5h2Q c�R 1 gQYaa"c *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 o or h e the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurat of my knowledge. I have read the conditions of approval, and I understand them, and that I abide by them. will Signatu Printed V�VL� C1S2�f APPROVA 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 Y11 Date �% 1 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 / tN Is us n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Willore 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 t app i� Is parcel on ivate well o public water? If private wel Apr ealth Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle tlieKhe—th'a-tNpplies Is parcel 6 septic hr public sewer? Y / Wil PN be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y0Wil ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: j Square footage of Use: 10 R (;()t_i' So • �T P mitted as: Under Section: 4 Supplementary regulations section: Parking formula: t I e i® e Required spaces: Y/ Items to be verified in the field: Tnenaefav • -nn4a- Vi ns: Y s If s, : Pro Y �N ) I f so, st: Va ' Y N If so, ist: SP's Y /,(N ) If so, st: Clearances: SDP's Revised 1/1/2011 Page 3 of 3