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HomeMy WebLinkAboutCLE201000043 Review Comments Zoning Clearance 2010-03-15so?l k, Applicati ®n f ®r Z®nin�` Clearance � Q )/) -•- �F�`` CLE # 7 -; i � %RCIN�P Zoning Clearance = $35 OFFICE USE ONLY �� / f� Check # 9 ©) Date: t b Staff. PLEA VIEW ALL 3 SHEETS Receipt # /-1 -PU14W PARCEL INFORMATION�j — � Tax Map and Parcel: V Existing Zoning r Parcel Owner: Parcel Address: Vi I u L;; Wt, t �\ State Zip " 0 03 / (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? h `N -21T�� j Address :Lj�r V��� �� City �d`U to V Zip 2218 Office Phone: ( Cell # ?0;;; 99-,� <6VVax # E -mail. 6At 64t\ ICS APPLICANT INFORMATION Check any that apply: Change of ownership Change of use of name New business Change �� Business Name /Type: 1(�1Gt� DbA C� OTfE' �� 1�`l° Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of _s�p.aces, vehicles, and any additional information that you can provide: J T— *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 accurat ie best of m no - L �read the conditions of approval, and I understand them, and that I will abide by them. Signature lxzetz' Printed r) QTG� 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 complies with the site plan as of this date. Notes: Building Official Date 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 /N Square footage of Use: u/ m LI, HI or PDIP zoning? If so, give applicant a Certified Is Engineer's Report (CER) packet. Y / N Y/ Permitted as: Will t sere 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 Circle the ona-that a}1 ies Parking formula: Is parcel on pr' we r public water? If private wel1,\ ealth 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 Is parcel on ti r public sewer? Items to be verified in the field: 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 # 7nning, to comnlete the following,: 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 Revised 04/28/08, 10/13/09 Page 3 of 3