HomeMy WebLinkAboutCLE201100136 Review Comments Zoning Clearance 2011-08-04I
m
Application for Zoning Clearance
= �� °t`r'��
CLE #,Q 1 Cd 1 70
� '�,,..r
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff: SM4 CdCj,_l&0
PARCEL INFORMATIO ��y PD S C
"(�tf®
Tax Map and Parcel: t Existing Zoning
�� LIC
Parcel Owner: 1
Parcel Address: 3q% k S cy,%jo`e j r_ a, k City a k V i t j c State V A Zip 2-LTO'
(include suite or floor)
PRIMARY CONTACT
,
� / %)
Who should we call /write concerning this project9 . �1 r\ \L
Address : �� (/i i Al el d 0 r% �% City ��l�( bjj_ State Zipv<�
Office Phone: C__) # �5e7- &)ZIax # E -mail
yCell
134--
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
r -
V W &5LaLu
Business Nam e: , tt,,
/�
���� �" iTe-C C-0`
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and:a additi nal info tion that you can provide: oZ errs d v- r
*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 acc ate to the best of my knowledge. I have read the conditions of approval, and�I understand them, andthat I will abide by them.
R064,z
Signature Printed of C_
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backt1ow 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 —1
Zoning Official Len_y� Date �d
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:
Is/
Is us n LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /Oi
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 u is w ter?
If private well, provide Hea th De ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one tha
Is parcel on septi or public sewer?
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 1-700
@/N // On
Permitted as: hasiN� �5
Under Section: -L
Supplementary regulations section:
Parking formula: S�
Required spaces..
Y/
Ite o be verified in the field:
Inspector : Date:
Notes:
Violations:
If �"Z '
Ifs , ist:
Proffe s:
Y
If ist:
Varia
Y/
If so, st:
SP's:
Y/
Ifs ist:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3