HomeMy WebLinkAboutCLE201100166 Review Comments Zoning Clearance 2011-09-20Application for Zoning Clearance'
OFFICE U 01"ILY
PLEASE REVIEW ALL 3 SHEETS
,&E
Check # 0 10 Date: C1 Cl
Receipt # Staff: M n S
PARCEL INFORMATION A
A
Tax Map and Parcel: 3 -� / Existing Zoning /f
Parcel Owner: &O Xlie l �� i9 L IK%C r^fSSOG 1 ft �t�
Parcel Address: -A2 /J 1o0x1t -e_ Io_Tr4.ckty C AA-r- o etw k State /f . Zip 2zfv
(include suite or floor)
PRIMARY CONTACT / j� �'
�RTrL1G ECer tA
Who should we call /write concerning this project? �/ t✓L, /,e
Address : / • 6 &X j:jg'7r City (_httY,//Am /lc State (1114- Zip z-,z3ro,5
Office Phone: Cell# q.S3- 600`j Fax #o2`,J - ,*16 E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of n ame New business
*
Business Name /Type: fdx'f'+t iA_ I'Vi ( ( (ZER,CtiS — fe"n� if V ftV 11-12r1111-12r1111 ^ s
Previous Business on this site /;r nA
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: 15lt4ok -C _700y
*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 Printed �(c7l G He ('�G lOC
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 t---- Date Ct
Zoning Official Date Z0 //
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice:. (434) 296 -5832 Fax:.(434) 9724126
Revised 1/1/2011 Page 2 of 3
t<l,
iv\
Intake to complete the following:
Y /(0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
0/N
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that. lies
Is parcel on Fi'vate or public water?
If private well, provide 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 septic or public sewer? Or � J flues
Y/0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /NN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninLy to complete the following:
Reviewer to complete the following:
Square footage of Use:
' Y%/ N n
Permitted as: •1- A 11
Under Section:
Supplementary regulations section:
:b?
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
ViolAions:
If so, List:
Proffe s:
If so, List:
Varian e:
Y /
If so, List:
SP's:
Y / N
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
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