HomeMy WebLinkAboutCLE201000007 Review Comments Zoning Clearance 2010-05-18P_
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Application for Zoning Clearance-
r Zoning Clearance = $35
OFFICE USE ONLY
Check # Date:
Receipt # S Staff:
PLEA REVIEW ALL 3 SHEETS
PARCEL INFORMATION y�
- _ -
Tax Map and Parcel: 3-7!9G0-G(3-0'3--0r73-41 Existing Zoning-
Parcel Owner:
Parcel Address: 19 3 +" n'�`f City (2: 1) e State Zip VA I I
(include suite or floor)
PRIMARY CONTACT �A
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Who should we call/write concerning this project ?.
Address • l J (o 16� 6 - Ave- City Sc L' State VA Zip 7-416 3
Office Phone: c5%40) -3-1 a -0 b 1 Ci Cell # C'✓-7 ` - 8 080 Fax # D91 9J E -mail i��j er-@ ►^ z.-n . cor+,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name Jr' New business
Business Name/Type: :�$jc^ IT -k-st DRA Sun 0 944
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available rking sPpces, number of
4— I� �'�.p `oy
vehicleess,, and ny additional information that you can prgvicje:, ►'�Y� +yYa S���1 r �-S ,
1� 3 �/ej-" t1t I 0 k ' , L,;}
*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 ac ate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature G'1.� Tom/ Printed DO P'\ �5 �tJ�j2 r
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] 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 cq►plies w the site,pl as of this date.
Notes: -� C/ �C'l
Building Official Date i f
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, 10/13/09 Page 2 of 3
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Intake to complete the following: Reviewer to complete the following:
Y / - - - Square footage of Use: 6 .J
Is use m LI, HI or PDIP zoning? If so; give applicant a Certified-
Engineer's Report (CER) packet. / N
Permitted as: n -Y)
WY/ �5 ti
ill Ocre be food preparation? Under Section:
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 publicya erg
If private well, provide Hea i D partment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap lies _
Is parcel on septic or public se r?
Y/N
Will you be putting up a new sign of any ]find? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # In t-) 9—y `j v3`/
7nniner to emmnletP the fnllnwinue
Parking formula:
pJ
Required spaces: -- / o �
C -� Gt(�
Y/
Ite to be verified in the field:
Inspector : Date:
Notes:
I
Violations:
/N
f so, List:
P offers:
IN
If so, List:
Variance: &I
Y/
If so,`t -At:
Y / SP's:
N�
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3