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Home My WebLink AboutCLE201100206 Review Comments Zoning Clearance 2011-12-15Application for Zoning Clearance CLE # OFFICE U Y Date: 1 PLEASE REVIEW ALL 3 SHEETS Eheck# Receipt # Staff: YYl v PARCEL INFORMATION Tax Map and Parcel: ., ✓ ki ' �� (1 _ ! : h Existing Zoning l Parcel Owner: v �• V i Parcel Address 1�� .. �1' City ; �/^ 1 State VA Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address :1 0;5 OlarA- ' �Ql l.r-ir y7� Y CC - State �G. ZiP414 X11 N- it 50 �a- 3ao•Qaab '31.2511� Office Phone: Cell # Fax # F'J�' E -mail �1J 5,r1 APPLICANT INFORMATION Check any that apply:: Change of ownee- r-s- h�ipp— Change of use Change of name New business -- Business Name /Type: 1 C n�nS0''1 Previous Business on this site7-Vl\l 13-f> Ge-` -r ►GC Cx-r,�rQ r' 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: *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 certi 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 acc ate to the est of my lrnowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Printed 1"Y�6 \�, Signa a 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. [o 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 l f S f Zoning Official P41 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 l rc,, Intake to complete the following: Y /O Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will De 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 p lic water? If private well, provide Health nt 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? Reviewer to complete the (following: Square footage of Use: q —1 66 PN \U mitted as: Under Section: �g . (aa� Supplementary regulations section: Parkin formula` I @ p Required spaces: Y/N " -' Items to be verified in the field: Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. , a �! h Inspector : Date: Permit # Y n Notes: Wi ere be any new construction or renovations? If so, obtain the proper Permit. Permit # 7.nnina to cmmrilete the fnllnwinu: Vi ation • Y/N If s st: Pr s: Y N Ifs ist: Var' VN e: Y/ If s t: SP' Y/N If s ist: Clearances: ,Q g SDP's Iggg- lb (p �j awo UP - V4 Revised 7/1/2011 Page 3 of 3 A-c-rC- 679v U— c�C) — ©v — 002 CA Ltd zv-