HomeMy WebLinkAboutCLE201100155 Review Comments Zoning Clearance 2011-09-06e, 1
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Application for Zoning, Clearance''
CLE # r 1 Cb I's t)
f�fiCiiN1P ,
OFFICE U E 0'9
PLEASE REVIEW ALL 3 SHEETS
ate:
Check # ((� Date:
Receipt # Staff:
PARCEL INFORMATION
A�
- Tax Map and Parcel: _ _p_ _� ' y __ _ _- _ _ _ _ _ -_ __ _ ___ Existing Zoning L9 A
Parcel Owner: /�''�lCtU�'e.1 af'fasti..k C_QA.MJQ -ul
Parcel Address: Y-Z 3 _ Umdn. RJ City ( %Wa . State [PCCh a,, Zip SI
(include suite or floor)
PRIMARY CONTACT CC
Who should we call /write concerning this project? (!'�.U','1 Qr�.J� -1
Address: 3 �(� iQio A,f,'N„ city State VA Zip 2,Zf34
Office Phone: L� Cell # 4341 t '�- Fax # E -mail %. �- tL&h&w m=&4 -a s.:,t, 6a,, C
APPLICANT INFORM4TION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site %tbior► Ca.binJS
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: C,,Lb AAA- ',�G aj,2 2- 1�+T
*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 n�t knowled e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed U-tfc L4--%� J
AP ROVAL INFORMATI N
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 t(
Zoning Official / Date 2�0/
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
C""_1
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Intake to complete the following:
Is/
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
Will Ptere 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 pri to h or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on p$br public sewer?
Y J/ N
dill you be putting up a new sign of any kind? If so, obtain proper
Sign permit. fek-O n ZAZSs ;,,J SL -1
Permit #
Y /
Will'frere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to vmmnlPtP the fnllnwinu-
Reviewer to complete the following:
Square footage of Use:
N n
Permitted as:
Under Section: /00
Supplementary regulations section:
Parking formula:
Require paces:
Y/
Item e verified in the field:
Inspector : Date:
Notes:
Viol ions:
If
If , ist:
Proffe
Y/
If so, L'
Var' nce:
Y
If so, List:
ON N
If so, List: SP —76— l 00
Clearances:
ALE 9'1 - 1 -6S
SDP's
Revised 1/1/2011 Page 3 of 3