HomeMy WebLinkAboutCLE201000022 Review Comments Zoning Clearance 2010-02-26'U� WhG7�
Application for Z®nin Clearance
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CLE #
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Clearance = $35
OFFICE USE ONLY f _
Check # Date:
PLEASZoning
REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
a12.— 3 — Z O Z Existing Zoning
Tax Map and Parcel:
Parcel owner: Ro.� e.&f _j It R ett 6 e s f
Pic.
Parcel Address: IZI 16 :VNC*P_tj,4 �t OA) �y e�U2IC State !/ � ZipZZyo
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address : X660 N-A eh Gxk C�_, City N -C-�k� State Zip
Office Phone,:_ �Sy 2°� G "3`� Cell # �s•4A. ' Fax # E -mail r l O�Olte �l@ \veld,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use��\\ Change of name New business
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available pa king spaces,l umber of
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vehicles, and any additional information that y u can provide: ew1
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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. ! —
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I hereby certify that I own or have the owner's permission to use the spacetindicated on this application. I also certify that the information provided
is true and accurate)b the best of my knowled e. I have read the conditions of approval, and I them), and that I will abide by them.
/understand
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���(� Printed �( �� 1K l t d J P X d �PG�?o
Signature (/U
AP ROVAL 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 complies with the site plan as of this date.
Notes:
Building Official Date t o
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
Intake to complete the following: Reviewer to complete the following:
Y /� Square footage of Use: � � Z s
Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. Y� / N p
ermitted as:c 01 r
Y
Wi tkfere be food preparation? Under Section:
If so, give applicant a Health Department form.
Zoning - review -can notbegimuntil we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or pu 1y "a r?
If private well, provide Health -tment form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or p 1 c s wer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to emmrilptp the fnllnwinor:
Parking forma a:
t ZS
Required spaces: / / /. � )
Y/N
Items to be verified in the field:
Inspector
Notes:
Date:
Viol ns:
Y�
If so, List:
Proffers:
Y/N
If so, List:
r
Y�- 0 11,E
Varia e:
FIList:
SP's:
/N
f so, List: I"
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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