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HomeMy WebLinkAboutCLE201200037 Review Comments Zoning Clearance 2012-03-07Application for Zoning Clearance CLE # � .Ji: 7Q #:'�"'' ,;�,����� OFFICE U NLY PLEASE REVIEW ALL 3 SLEETS # Date: -1 Receipt # TaVL Staff: PARCEL INFORMA O&0-am- Tax Map and Parcel: Q [ Existing Zoning _PI Z Parcel Owner:�r � City State ZiParcel Address: p (include suite or floor) PRIMARY CONTACT r p Who should we call/write concerning this project ?bl��G� Address: 51-e o V2-> City V7 T1 e— .- State V Zi Office Phone: ✓ 4 Cell # 3-'4 - 7a�Fax # E -mail u APPLICANT INFORMATION Check any that apply: Change of use Change of name New business Change of ownershi[p� ii n Business Name /Type: I �Z i V1 i (\0, �.n/ © ANN Previous Business on this site 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: �'. 6*�S S �3-� ='` *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. II have read the conditions of approval, and I understand them, and that I will abide by them. Signature .r C�_- �_ Printed AJ 71IL/ AP - R`OVAL INFORMATION [ Approved as proposed [ ] Approved with conditions [ J Denied [ ] $ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117. [vVNo physical site inspection has been done for this clearance. Therefore, it is not a detenninafion of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: �— Date / Building Official Zoning Official &6Z Date / a Other Official Date County of Albemarle Department of Community mveiopment 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 19 Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified YN) Wi 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 ublic mate ? If private well, provide Heal 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 dQ2ublic sewer? Y/N Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper Y/0 Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7,nninv to complete. the following: Reviewer to complete the following: Square footage of Use: P ,�rrSt (11c,tax- iD / �N IV lnA t (�� utt ed as: Under Section: �� 'IY QI ✓lUU W Supplementary regulations section: Parkin formula:,. �oo ' Ob Required spaces: Y/N Items to be verified in the field: Inspector: Notes: Date: Violations: Y/N If so, List: offers: lYJ /N `�f so, List: C'fPMn2y a ca WW COQ.. Variance: Y/N If so, List: 's Y) /N If so, List: Clearances: SDP's Lo - Revised 7/1/2011 Page 3 of 3 )�& q t , i cr i K �1 L7 1' "I-,; \ (P { � i { i l i r t{ 1 i J � f 5 1 r i t t 1 5 i i Jj l4j s i 1 i ' i - 4 ••�- .•�- +.�a.+.w rte. ( ..+u.......�- ems.. -rr. wn+..�. "' _ / � .�� i K �1 L7 1' "I-,; \ (P