HomeMy WebLinkAboutCLE200900127 Review Comments Zoning Clearance 2010-05-25Application for Zonin Clearance
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CLE #
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Zoning Clearance = $35
OFFICE USE O LY
Check # � 7 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # '71P05S I Staff: J PU r rte/
PARCEL INFORMAT ON /� �j
Tax Map and Parcel: w ( `�� Existing Zoning 1_`� / /ly%% a,140 e,
Parcel Owner: RA TO 1,� g —R -mww uy-j
Parcel Address: DA • City State VA Zip 229x 1
(include suite or floor)
PRIMARY CONTACT Q� n S
Who should we call /write concerning this project?
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Address: 610 WQQ ��20� (Q � � City �g►1AAU%5AVfState Zip
Office Phone: ( `11 Cell # ? 63 Fax # I�� E -mail �pnp S°ihcV i 4 aSCOCtQ
APPLICANT INFORMATION
Check any that apply: Ch��ange of ownership Change of use Change of name New business
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Business Name /Type: l�h 0 t Pf S( 0C, On-AS , Vw
Previous Business on this site Q �jQl
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: 1 —3 S Qf:h .•
f w QA 064A 1I" W&= 11a61 �Uwv e-O 412n a
*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 est of my knowl ge. I have the conditions of approval, and I understand tthem, and that I will abide by them.
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Signature ate/ Printed 3 of hp,,1
IQ P AS
APPR INFORMAITION
f/] 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 ( doll
Zoning Official 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 04/28/08 Page 2 of 3
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COA
Intake to complete the following:
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Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Reviewer to complete the following:
Square footage of Use:.
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Permitted as: �/� p C"C i
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Will there be food preparation? Under Section:,
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or ublic Ovate
If private well, provide Healt Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies T
Is parcel on septic or public sewer?
YVl
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
0/ N
Will there be any new construction or renovations?
If so, obtain the proper Permit. ��r
Permit # 0 �`j y�j � �✓ Ilr 1114
7.nnina to rmminlpte the fnllnwinar'
Parking formula: l , S 3
Required spaces:
Y /(NJ
Ite o be verified in the field:
Inspector : Date:
Notes:
Violations:
If s L:
Proffers:
so, List:
Var nce:
Y % I
If so\,-4, ist:
SP's:
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f so, List:
1
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3