HomeMy WebLinkAboutCLE201000040 Review Comments Zoning Clearance 2010-07-19Application for Zoning Clearance
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Zoning Clearance = $35
OFFICE USE ONLY
Check # �, Date: J
PLEASE REVIEW ALL 3 SHEETS
Receipt #-7Z),3 Staff: GiJ' 1
PARCEL iNFORMATTO & Tax Map
Parcel: 0�_ �y - N ' ���(�D Existing Zoning
and �
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Parcel Owner:
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Parcel Address: !_`� 'I<,AD L 6ke WO City tate N,/A Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? GP.P5:f �
Address : wJ wCOWWK NWJ- City Cf 21, 1 2 ALL te" 0-
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Office Phone: (L ) Cell # 29 -179 Fax # E- mai1C'CY1(�'�it'r�.��i ►�11��.�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ✓ New business
Business Name /Type: 7AdW,14D'1_ 0A 'MAS- Q—) 8111V_
Previous Business on this site f3��
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:
*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 acc rate to tl est of n 1Q]Ow ed/ (lhave read the conditions of approval, and I understand them, and that I will abide by them.
Signature �, /G�i/ Printed EP91f--
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APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacl&ow 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: D bf 0
Building Official - Date
Zoning Official Date ,h0
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Other Official i Date 0
J
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: 2qc 4
Is "an LI, HI or PDIP zoning? If so, give applicant a Certified
.Engineer's Report (CER) packet. I Y / N �¢,c,��
Permitted as: �jz"'�r►e- u6hwLeyq
Y
i ,�1 ll there be food preparation? Under Section: �L•�' -o2..-
If so, give applicant a Health Department form.
Zoning review cannot- begin- until -we receive approval from Health Supplementary reg ations section:
Dept. FAX DATE �L� 01-
Circle the one that applies Parking formula:
Is parcel on private well or C�jp3aftment ater?
If private well, provide Heal form.
Zoning review can not begin until we receive approval fi•om Health Required spaces:
Dept. FAX DATE
Y/N
Circle the one that appli Items to be verified in the field:
Is parcel on septic or ublic sew
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 #
7nnin¢ to emmnlPtP the fnllnwinfy-
Violaatttiions:
Y �rL,
s
If , ist:
Proffers:
Y /
If so, List:
Variance:
/N
If so, List:
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SP's:
(D/N
If so, List:
r,1-
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3