HomeMy WebLinkAboutCLE200800024 Legacy Document 2013-01-03Application for
Zoning Clearance
Building Permit
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#BO07- 02556AC
OFFICE USE ONLY
® Zoning Clearance = $35 CLE # �Z %
PLEASE REVIEW ALL 3 SHEETS Check # Date: - / —!J
Receipt # /„ Staff.
PARCEL INFORMATION
Tax Map and Parcel: 32 -19H
Parcel Owner: University of Virginia Foundation
Existing Zoning PD I P
Parcel Address: 1670 Discovery Drive city Charlottesvi 1 le State
(include suite or floor) U 1 to 240
VA
PRIMARY CONTACT
Who should we call /write concerning this project? Todd Marshall
Address: P.O. Box 400218 city Charl ottesvi l lestate VA
Zip 22911
Office Phone: 4( 34) 982 -5304 Cell # 531 -3644 Fax # 982 -4852 E -mail stm7v@virginia.edu
APPLICANT INFORMATION
Business Name/Type:
Previous Business on this site
Pinnacle Pharmaceutical
none
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
Ice Space
*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 10 r ve the owner' ermission to use the space indicated on this application. I also certify that the information provided
is true and accurat o the best of my ]mow ag . 7have read the conditions of approval, and I understand ahem, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
1/1 Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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 c Date
Zoning Official ri 4 Date &,-2- y`fi
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
4218
Intake to complete the following:
❑ YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [�1 O
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
❑ YES RNO
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic or public sewer?
❑ YES EKNO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
[EYES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 0 7 -a
Zoning Tech to complete the iouowmg:
Violations:
F] YES ❑ NO
If so, List:
Variance:
❑ YES ❑ NO
If so, List:
Reviewer to complete the following:
Square footage of Use: V
/(YES ❑ NQ r(�
Permitted as: nqj�' wii Ace,
Under Section: 0+54
Supplementary regulations section: /
Parking formula: 1 0
Required spaces:
❑ YES ❑ NO
Items to be verified in the field:
Inspector : Date:
Notes:
511106 Page 3 of 3