HomeMy WebLinkAboutCLE201100146 Review Comments Zoning Clearance 2011-10-26Application for Zoning Clearance
CLE # X1 I MV LA
OFFICE US , Q1
Check # �I U� Date: J Wit
PLEASE REVIEW ALL 3 SHEETS
Receipt # S?>q�,52 Staff: i
PARCEL INFORMATION
Tax Map and Parcel: 04900-00-00-031140 Existing Zoning
Parcel Owner: PITP R(", h,j SiVe. L'C D
Parcel Address: �vq� P�.k( c��(�istc �a(�'�3°City State ly/-/' Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address b 5c /O State Zip ZZ��
bell city
Office Phone: ( 2Z D3; Cell # q3q -2_V-- Fax # E -mail K4" t16 C,, Q
APPLICANT INFORMATION
Check any that apply: _Change of ownership Change of use Change of name New business
Business Name /Type: Al e__ J7 yI o, Qv�Cal6�V ��-�i LIJ E Qrga, �0�.4PF ,T ' 24J2c.l C�►'I��Z
Previous Business on this site baZ.
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: f+j, VQ1- &&&(2cQ2e �,1tirG
*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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature A 6Printed M+�_", I U-jerweje-
APPROVAL 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 „ Date
r
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
Intake to complete the following:
Reviewer to complete the following:
Y /(r)�.
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will there be food preparation?
0/ N p n
Permitted as: % °-cJ�i 0 X, Zt,
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fi-om Health
Supplementary regulations section:
Dept. FAX DATE
SP's:
If /1,D
If so, bi
Circle the one that applies
Is parcel on private well o u Iii er?
Parking formula: j
Required spaces-
If private well, provide Hea •th-Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Y 04
Itemsfo be verified in the field:
Circle the one that applie
Is parcel on septic ok =/
SDP's
Y/N
Will you be putting up a new sign of any ]rind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
/ N
Notes:
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 2-1)11 - 333,1 ',-'
Zoning to complete the following:
Violations:
If /6rei st:
Ifs ; L /i,
Proffers:
List:
`•I so N
Vari nce:
Y1
If o, ist:
SP's:
If /1,D
If so, bi
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3 '