HomeMy WebLinkAboutCLE200800226 Review Comments Zoning Clearance 2009-09-039
Application for Zoning Clearance
CLE# 2009— Z
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OFFICE USE ONLY
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Zg Clearance = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # `7r2-IS / Staff:
PARCEL INFOWvIAT!ON
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Tax Map and Parcel: T 1� Tt r `I_ Existin Zoning-
Parcel Owner: ( ) a a g C 14 0f— L rL.�,
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i / 1p4 E Ls1fi ity State Zip
Parcel Address: 6.
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project? /Q-
Address : City State Zip
Office Phone: ON). V 2 3 166(cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of oo/ownership Change 'of use Change of name New business
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Business Name /Type: lam// -URCH OFr k1a.5-
Previous Business on this site 1 \J0 k1 _
Describe the proposed business including use, number of employees, number of shifts, available park'' 9 spj�ces, number of
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vehicles, a d any additional infor ation that you ca provic}e� �� u c i c/ .wt eopf
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*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 tha wn or have own 's p nnission to use the space indicated on this application. I also certify that the infonnation provided
is true and acc a ie best f kno e , . I a`we Pead the conditions of approval, and I understand them, and that I will abide by them.
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' Printed � �C �
Signatur i Ce 7ti
APPROVAL INFORMATION
k 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 Date i0
Zoning Official �� Date 2�
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 04/28/08 Page 2 of 3
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit
ti V
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 2-001— !906 N-' Ct -c-rL4e
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Inspector Date:
Notes:
Vio tion •
Y/
If o, ist:
Intake to complete the following:
Reviewer to complete the following:
Y /(NN
Square footage of Use: I aq,
Is usc' n LI, HI or PDIP zoning? If so, give applicant a Certified
Var' e:
Y/N
If so, List:
SP's:
/N
so, List:
Engineer's Report (CER) packet.
/ N
Y/Dhbe
Wil food preparation?
as: G
Under Section:
Clearances:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulation section:
Dept. FAX DATE - _ -- -- - -
_
I
Circle the one that applies
Is parcel on private well or p water?
Parking formula: / 1
7�
If private well, provide Health Department orm.
Zoning review can not begin until we receive approval from Health
Required spaces: /
Dept. FAX DATE
i !*
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit
ti V
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 2-001— !906 N-' Ct -c-rL4e
�rP�i• �wi r��er-rc� - $, d AY ,
7nninv to rmmnlPtP the fnllnwinv-
Inspector Date:
Notes:
Vio tion •
Y/
If o, ist:
Proffe s:
Y
If s
Var' e:
Y/N
If so, List:
SP's:
/N
so, List:
Clearances:
SDP's O
Revised 04/28/08 Page 3 of 3
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