HomeMy WebLinkAboutCLE201100164 Review Comments Zoning Clearance 2011-09-28Application for Zonin Clearance
CLE #
PLEASE REVIEW ALL 3 SHEETS
7Receipt#
OFFICE USE ON1�Y
Check # l 14 S45 Date: JS a -1,
q
Staff: 1�6^a.CIV
PARCEL INFORMAT N _ L
Tax Map and Parcel: o"" oW— Existing Zonin �
<` 1
Parcel Owner:
Parcel Address: 4�'f //e� S9�, ✓ City State �a., Zip aQCL
(include suite or flo r)
PRIMARY CONTACT
S ��7S /`� Cliff
Who should we call /write concerning this project? O
Address: 1 /,P l A9 Lz1VG -7oN 6,V2 ;2 Y 3 City A? L 7)-6- 7o /--State �^ . Zip � a
, /y
Office Phone: (� � Z S = S� /I Cell # 73 -3'2 //Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site r—DR1`t
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that ou can provide: vC& , e_yF`1 P tCX ES)
t PL o f != 2 0 P1 1 �freh
2h-7 -
*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 ��� S E Pff /fS/`1 GL fq s ff
APPROVAL 64FORMATION
Lej 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 1/1/2011 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Wil ere 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 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?
Y/ N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /� N/
Wil ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninL, to com lete the followin :
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
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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