HomeMy WebLinkAboutCLE201100197 Review Comments Zoning Clearance 2011-11-18Application for Zoning Clearances
CLE # SDI 1qQ
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O
Check # '� l Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: �Z Existing Zoning
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Parcel Owner: tt�{ 0 A 5 %06 O 6 (� �� ka
Parcel Address: 204 Al bi/�1�i Ak • City 06'6 lk� State V A- Zip-221h
(include suite or floor)
PRIMARY CONTACT
Who should' we call /write concerning this project?
Address: �• �, r i�c Ga g �(? / ^ J City A— State 61-4 Zip
S3 4
Office Phone: (,�:yg ?Y3-65-11 Cell # Fax # ( D �3 . 15 E -mail b' r', n b2g lb-7-
INFORM TION
.APPLICANT
Check any that apply: Change of ownership Change of Change of name New business
/use
// /
Business Name /Type: (y 01 rC�.0 I ;3""4 z z'4
Previous Business on this site e awl
Describe the proposed business including use, number of employees, umber of shift s, available p king spaces, number of
v icles, and any additionaliformation that you can provide: c 3 u t� /ft fii �t
it+w' a —� r� a! �4�c l t c s
*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 qy knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed /Um(
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 r Date o {
/
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 7/1/2011 Page 2 of 3
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Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
&>/ N
Permitted as: 4�1-- W n! /_' .
Wil t ere be food preparation?
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well o public water?
J
If private well, provide Hea arhnent form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that a=publicsewer?
Items to be verified in the field:
Is parcel on septic o
Y N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y /D
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to rmmnlPtP the fnllnwinu-
Violations:
Y /(�)
If so -, ist:
Pro ers:
Y/V
If so, List:
Variance:
Y
If so, ist:
SP's:
so, List: q 3 J
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
/j ,/ [County application name and number]
was provided to io c o A5.4 r !^� +�-� t % � y fie owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 061066600 1 Z 3d o by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on
Date
V Mailing a copy of the application to X( /15SDUaf`M�T `1
[Name of the record owner if the record owner is a pers n;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
on 1116- 11 to the following address:
Dae
9f�C_7 Ai
[address; written notice mailed to the owner at the last known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of Applicant
Print Applicant Name
Date
IcLEGTED
.ILINO PLAN
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YORK NOTES
QIWJW FOUNTAIN,, BY S.KAY, HANDICAP A36HT, IF RMV BY
XAL CODES.
MUTURE AND EaWME r NJA SHOWN FOR REFERENCE ONLY.
(ISTIN6 .YWORS DEEP SINK, PROVIDE 96" MOP STRIP ON
D. 4aw WALL.
MMERATOR, N.W.
TM, NJA COORDINATE EXACT LOCATIONS, ROWH INS, AND
.EC. FWAREMENTS WITH DIMOLDS SECURITY DW6S.
on DERCSITORY UNIT, NJL. COORDINATE EXACT LOCATIONS,
CM INS, AND ELEC. REMIR04 NTS MTN DIEBOLDS SECURITY
FINISH PLAN
3/16" = I' -0" 0.735.06 - PP
FINISH LE-6W
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GENERAL DOOR NOTES:
I. ALL DELIVERIES TO THE MW SITE S V" BE APPROVED AN�l
THE 6EHERAL CONTRACTOR i
2. HARDWARE SUPPLJER TO CHECK AND VERIFY PROPER LOCK
AND HARDPMRE AC61 aME5 FOR EACH DOOR TYPE AFd GQ
9. ALL 6LAS5 WITHIN I6' OF ANY DOOR SNALL BE TES
4. ALL DOORS WED IN TH6 MEANS OF MESS OM) SHALL BE
AND SWINIb IN THE DIRECTION OF E6RES6. IF ANY LOEMNS
DEVICE IS TO BE PROVIDED, ONLY NWA APPROVED
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