HomeMy WebLinkAboutCLE201100216 Review Comments Zoning Clearance 2012-01-18Application for Zoning Clearance
CLE # Q I - AIG
OFFICE USE Y
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map Parcel:' U � �l0 - 00 � - � 10 U Existin g Zonin g �
J
Parcel Owner:
1 �
Parcel Address: City State Vt ZiARL
(include suite or floor)
PRIMARY CONTACT /
project., �%:
Who should we call /write concerning N
/this
Address: � /S_ /' /�t frll j(J�/ ersm / Ij ty /, 0Y RS- City °,d, 2�L"ffLt zW GC/ State ,t1A Zip
,
Office Phone: Cell #WVE W-M 3 Fax # E -mail %V'fC Ili CV /l�%� k(% �GF /• �'Q1N
e
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
II //� ®®
Business Name /Type: /1/'�!}�14 50' 1 Otm u
Previous Business on this site ,S4w 1511y'rll" W AWA Mel/"�iyJ ~OM er)
G
Describe the proposed business including use, number of employees, nuiru�b.er of shifts, available parkin/g spaces ces33 number of
ei WA V,40 Qv �6LCA �1'li�t9�1`d)7
vehicles, and an additional information that you can provide: , 11A,4 V9(l'MUZ�
n�e.A�i ^u ,�YLGGI,°G�l ��fi1(
*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 �� L� Printed il'1074 A- 4,t1V, y
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 _ o Date i ! I
Zoning Official .�- `f_rul' 7�r.� _ 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
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 public w_ate •�
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 o Su is sewed
Will, belp Ztrtmg a ne- w sign y�t� proper
Fin ro d? If so, obtain
Sign permit.
Permit #
Y /
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: ;ID
-0 /N
Permitted as: 'm
Under Section: L5 A
Supplementary regulations section:
Parking formula:
Required spaces:
Y /(
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/1
If so, List:
Proffers:
Y/N
If so, List: 01 15-
Variance:
Y /(ID
If so, List:
SP's:
Y/6
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
6, �,� P� �Wo� qe