HomeMy WebLinkAboutCLE201100144 Review Comments Zoning Clearance 2011-08-11Xy0 -o-0
Application for Zoning Clearance
100
CLE # 01 1
• , � /)iGli�1
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # s-117%0 Date:
Receipt # Staff: tJT
PARCEL INFORMATION �/
'� y - 9"j A Existing Zoning
Tax Map and Parcel: 1
,1-
Parcel Owner:�� nN S 1+1 e-0 f'_ ( (Zc> Se, \�o3,3
p
Parcel Address: M'i &D .SC City (11,6tr /o�St4 State VeI9 Zip Zz 7 b
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
C�1 ✓ %Jl/r- lC City te VA Zip C93 M4
Address : •_?3 b 3 T
Fax # E -mail P����? y� SPA r
Office Phone: Cell # 1 " 5" VF
. 4f �0EJ•CCVI.
APPLICANT INFORMATION
Check any that apply: Change ofjownership Change of use Change of name New business
a
Business Name /Type: �.Jo) "/)'+ lia.l(dUV2 e— r,
i
Previous Business on this site /Z,L( Uj 9eG ,, � VIJo-4-.efAr7uk
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 ormove the use to anew location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the own 's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate the best of ny 1<11 • ledge. I have read the conditions of approval, and I underrstandCthem, and that I will abide by them.
Signature C Piinted, a (i��a c` J r
APPROVAL INFORMATION
.�A' 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 Date
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 7/1/2011 Page 2 of 3
r', 14,
Intake to complete the following:
Y /I
Is us m LI, [II or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /�)
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 is . ter?
If private well, provide Heal h Depa tment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septicprrpjTM sewer
Y/N
Will you be putting up a new sign of any kind?
Sign permit,
Permit #
If so, obtain proper
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:S 0 �d
V/ N
Permitted as: r6;i -pr i�
Under Section:
Supplementary regulations section:
Parking formula: .P 1) L &,/
Required spaces:
Y/R
Item�t be verified in the field:
Inspector Date:
Notes:
Violations:
Tt /N
so, List:
� j�
Proffers:
�N
If so, List:
Variance:
Y/�
If so, Zest:
/
SP's:
Y/o
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3