HomeMy WebLinkAboutCLE201000023 Review Comments Zoning Clearance 2010-02-18r
Application for ZoninE Clearance
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CLE # DSO — �
OFFICE USE O LY
f% �v �� 17'f�
Zoning Clearance = $35
PLEAREVIEW ALL 3 SHEETS
Check # Date:
Receipt # '4 7 1, Staff:
PARCEL INFORMATION v eld'v el o o- v o D
Tax Map and Parcel: 64ar z — a 4 o4 ,'- /Z Existing Zoning
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Parcel Owner: 9 /,/ ,�C'i" �� o ��. /� �� e/ e:6 �flv' C'o,.oi J;�l �orr��- ✓�
Parcel Address: 415/1 City G'/Z., /s /,/yo State V1,4 Zip ",9
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project? ''- e �-f7 i� L
Address: y /1 "� �' / I � r�ity44 h���-,�� ate Zip �
Office Phone: (,f 7/X C ell MY Zz iax # E -mail
APPLICANT' INFORMATION
Check any that apply: 3,/ Change of ownership Change of use Change of name New business
Business Name /Type: 1 %.S�51 �7 /,2
Previous Business on this site
Describe the proposed business including use, number of employees, num er of shifts, available parking spaces, nu ber of
vehicles, and any additional information that you can provide:
*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 1 ve the owner's permissio4reanditions e space indicated on this application: I also certify that the information provided
is true and accurate t ie s of my lcnowledge. ha of approval, and I understand and that I will abide by them,.`
them,
Signature Printed
APP OVAL IN ORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow 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 detei7nination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official �— Date ZL
Zoning Official Date ��� 1. 0
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
c/
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there be food preparation?
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 or public water?
If private well, provide 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 septic or public sewer?
Y/N
Will you be Putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoninp—to comDlete the following:
Reviewer to complete the following:
Square footage of Use: /p bo S (�
/N
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ermitted as: c5 G✓!��'1
Under Section: '� tb o`
Supplementary rggulations section:
/I ( Cc_
Parking formula: — —�-
U��( J
Required spaces-
1 gQ C@
Y/
I 4e be verified in the field:
Vi t' ns:
Y
rIfs
o, Lisf:
Proffer k.
Y/
rst:
Var' e:
Y N
Ifs 'st:
SP's:
Y /
Ifs ist:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3