HomeMy WebLinkAboutCLE201000042 Review Comments Zoning Clearance 2010-03-15r0k
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Applicati ®n f ®r Zonina Clearance``
CLE # -'--6) 0 - -q Z
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Wzoning Clearance = $35
OFFICE USE ONLY
Check # 55 .-T Date: ' ✓ ✓'��
PLEASE REVIEW ALL 3 SHEETS
Receipt# _7) r�c1 Staff:
PARCEL INFORMATION i PtW
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Tax Map and Parcel: lA/I / Existing Zoning
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Parcel Owner:
Parcel Address: VIC) City C_\_� \i_Ak t State V A Zip )DRbl
(include suite or floor)
PRIMARY CONTACT /+
Who should we call /write concerning this project? 0, lam
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Address: C tom_' 1� �1 1% l ., �lr� Cit}�,V \� 1 State y ! \ Zip�Z� �1
Office Phone: 9 . x%72 -01c& Cell # Fax # E -mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: C—O-u `� Cy\ .�fck_e --7. %�esj d � y IL�A^iAq eMa,,
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Previous Business on this site 0 (--� 161 oL, ` 1
Describe the proposed business including use, number of employees, number of shi 'ts, ava' ble parking s ces, number of
vehicles, and any additional information that you can provide:
Dad.- .1 1' �-
*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 a �teto be st o2iny nowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature( GZ � -�.Q� Q-- Printed
APPROVAL INFORMATION
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 determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date i �+
7 7
_ Date
Zoning Official , '
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 / 6)
Square footage of Use: y
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
/ N
�erriiitted
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as: NHS 5 i L�
Y il tOic
Will t"``�rrriere 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 one that applies
Parking fonnula:
/�j,�o
Is parcel on private well r puPepaitmentfoirn. r?
If private well, provide Hea 1
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y //PV
Circle the one that applies
Item, o be verified in the field:
Is parcel on septic or ublic s ?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
I Notes:
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7,nninq to comnlete the followinu:
Violati s:
If /
Ifs ist:
Proffer :
Y L[,l
If gist:
II
Variance:
Y/[
If so, List:
SP's:
Y/6
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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