HomeMy WebLinkAboutCLE201100176 Review Comments Zoning Clearance 2011-10-11MOAL
Application for. ZoninT Clearance
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CLE # V
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY `� J w� I i
Check # Date: U1 1
Receipt # Staff. iY1Ct G
PARCEL INFORM TON /_y��
Orb —60 —00 0-1
Tax Map and Parcel: Existing Zoning
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Parcel Owner: I i Ct� �"� 1610 r
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Parcel Address: t,(/�1��PC�JCk9�X City 0vP10_t'fe5(j("Ntate V-4— Zip };;*qo
(include suite or floor)
PRIMARY CONTACT j
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Who should we call /write concerning this project? E l C � G(6 e` w �^
Address City State [1 Zip
Office Phone: ( cb �%�3� (o Cell # oC� (o `i ?0 Fax # �7E =mail d i-ct �cpwvi�GUt i�Pde 4-tei �c,
APPLICANT INFORMA 16N
Check any that apply:
Change of ownership of Change of name New business
puse—
\ ,•Chang�e�
Business Name /Type: �),!!�'�`{" ` t ` /� L.� �Yl� ' ��0�: A am b.
Previous Business on this site
Describe the proposed business including use, number of emplo ees, number of shifts, available parking spaces, n ber of
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vehicles, and any additional information t hat you can provide: , (Q-^ V if —
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*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. o nave -th o ape i sion to use the space indicated on this application. I also certify that the information provided
have
is true and a ra e t best of . r dg . read the conditions of approval, and I understand them, and that I will abide by them.
Signatur Printed G I " r ( Cv r6,1
APPROVAL INFORMATION
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:
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Building Official Date (0 (4
% Zoning Official Date c) Zh
v
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
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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
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 ubli wat r?
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 applie r�
Is parcel on septic or p lrfic sewer
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
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:
Permitted as: C"C-"
Under Section:
Supplementary regulations section:
Parking formula: l
Required spaces:
Y
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /�)
If so, ist:
Proffers:
Y/
If so, ist:
Variance:
Y/&
If so, List:
SP's:
Y /fq
If so, ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3