HomeMy WebLinkAboutCLE201100128 Review Comments Zoning Clearance 2011-07-18Application for Zonin Clearance`-
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PLEASE REVIEW ALL 3 SHEETS
OFFICE
Check # Date:
Staff:
Receipt #
PARCEL INFORMATION /� /y more'
1,,o 1 2-4 Existing Zoning ( C,!
Tax Map and Parcel: • i
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Parcel Owner:
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Parcel Address:_ �� City � ' r/� /� l� State l�/�l p oZ/
nclude suite or floor)
PRIMARY CONTACT 11,A4t111,41
Who should we call /write concerning this project?
Address :10L/ /. City C State /� Zip
Office Phone: �Z3 �1 Cell # 3% �0 �5'�4ax # IIV - E -mail P1',4
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: _���1K.�'V'�) ✓�
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking splws, nujjn�ber of
vehicles, and any additional information that you can provide: .l�P�' S Gt/f �Y4J2VS
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew 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 to the best of my knowledge. I I ave read the conditions of approval, and I understand them, and that I will abide by them.
Signature Za,4 Printed%'
APPROVAL INFORMATION
X)kpproved 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 Jr Date
Zoning Official Date
Other Official Date
County of Albemarle Department of Community lueveiopment
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: I Reviewer to complete the following:
Y /0
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
0/ N JJ
✓y�/
Permitted as: J 1D
Y / O
Will there be food preparation?
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well or ublic w r?
If private well, provide Heal trBri partment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applie
Items to be verified in the field:
Is parcel on septic or pfibliT c- sewer
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector: Date:
Y / N
Notes: l
Gl��
Will there be any new construction or renovations?
f
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y/N)
If so� ist:
Proffers:
Y/0
If so, List:
Vari ce:
Y/T
If so, ist:
SP's,
Y /(NJ
If so, Est:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3