HomeMy WebLinkAboutCLE200900124 Review Comments Zoning Clearance 2010-12-01Application for Z�onin Clearance
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CLE # i �[ — 12
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Zoning Clearance = $35
OFFICE U$E ONLY /J
Check # 1003 Date: 0-. `I/ '7
PLEASE REVIEW ALL 3 SHEETS
Receipt # -7 UO " / Y Staff:
PARCEL �3;z' ^vi�l`✓ii[ -` iivl`Z /� ;�
f i "_�� v0 - 2 (� (� -
Tax Map and Parcel: \ _ - Existing Zoning I�oWVL"��+3r
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Owner: �vw �k 4 U � i 7S
Parcel
Parcel Address: 12-W `' ` " U± AVL City e State V A Zip27/��
(include sui or floor)
PRIMARY CONTACT
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Who should we call/write concerning this project? ,o��fVit 0
Address: `�T� !�� City. State V Zip 22=6-z
Office Phone: (7 n 0lz319 bj Cell Thy 6()'3 "'Pax # '--- E -mail k
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: zQ_ 6 Q %� C t
Previous Business on this site (-\`D k9__
Describe the proposed business including use, number of employs, number of ghilts, available parking spaces, number of
information that `� -f Yla G (p
vehicles, and any additional you can provide: —
*This Clearance will only be valid on the parcel for which it is approved. If you change, inten§ffy or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that own r have the owner pe 'ssion to use the space indicated on this application. I also certify that the information provided
is true an accurat to the est of m), nowle e. I ave read a conditions of approval, understand them I will abide by them.
That
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Signatu "�'�� Printed Gl YV� 1 4C�1 �� S
APPROVAL INFORMATION VW6 o
Approved as proposed [ ] Approved with conditions [ ] Denied
Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 19.
[ ] 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: �r'
Building Official Date �W I s l o -�
�
l
Zoning Official Date
Other Official 1) 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
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Intake to complete the following: Reviewer to complete the following:
Y / Square footage of Use: _ 97
Is use'i 1, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N ro
fitted as: C¢IJ]�ec.
WilPtnere be food preparation? Under Section: a `I
If so, give applicant a Health Department form.
"Zoning review can not begin until we receive approval n om Health �u ppiementw re la ions section:
Dept. FAX DATE--
Circle the one that applies
Is parcel on private well or p lic ter?
If private well, provide Health partment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap es�,
Is parcel on septic o public �wer?
Y/N
Will you be pu ing up anew sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obta' the roper Pe iVk,01� Permit #
G-VLJU-Vv,�
Zonino to complete the following:
Parking formula: A
Required spaces:
Y/N
terns to be verified in the field:
Inspector:
Notes•
Date:
Vio ons:
Y N
If so, List:
Pro :
ffe Y /
If so, st:
VarP e:
If /(
If so, fist:
SP's:
Y/
If so, st:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3