HomeMy WebLinkAboutCLE201000028 Review Comments Zoning Clearance 2010-03-12Application f ®A Z®nin Clearance
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CLE # 2
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Coning Clearance = $35
OFFICE USE ONLY
Check # ef,Sl Date:
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PLEA REVIEW ALL 3 SHEETS
Receipt # Staff: j /
PARCEL INFORMATION ( ?/A/ y
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Tax Map and Parcel: Existing Zoning
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Parcel Owner:
Parcel Address: i �1 sirv,�iy1/rLO.� l�Ni� City uU��t�L�it- (Mate. Zip v�c��
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project ?/�Ct- ('/'�-
Address: / r� City P,6 ate V Zip191� O
Office Phone: (A , 3-S Cell# -q3y 10-&Yl ax #x-34 "9,434Sr3&, -mail
APPLICANT INFORMATION
Clieck any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: /r /2J, &4021
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Previous Business on this site NG�(,l� UWA&V&
Describe the proposed business including use, number of employees number of shifts, available parkin spaces, number of
iformation that can t $
vehicles, and an additiona4i you provide: t
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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 anew location, anew 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 Y11 best of my kno ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ca Printed vj A N P14 )--JI YA) 6
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977-4,5-n, 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' l0
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 / N
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Permitted as:
Y/N
SP's:
Y/N
If so, List:
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
Clearances:
Circle the one that applies
Parking formula:
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
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
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 permit.
Permit #
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7anina to emmrilptp the fnllnwinu:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
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Revised 04/28/08, 10/13/09 Page 3 of 3
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