HomeMy WebLinkAboutCLE201000047 Review Comments Zoning Clearance 2010-06-28rt
Application for Zoning Clearance
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CLE # V7
Zoning Clearance = $35
OFFICE USE ONLY
Check # /,,,115// Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7 ,Po Staff:
- PARCEL - INFORMATION - -- - -_ - = - -- - - -- —.- -- __- -
Tax Map and Parcel: Existing Zoning
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Parcel Owner: (1 C (-
,
Parcel Address: 3o-7 4 x n, CityC`' Cj(jN4!e So �1C State V Zi
(include se uite-oi floor)
PRIMARY CONTACT
'Wlio ?� 125"411
should we call /write concerning this project?
Address : 1� 1 City CI'►C(r�b�} �fSrVi {le State V�'t Zip
Office Phone: Cell # 9 Fax# Eanail `i4�-nrCkM�GSS�Yc�irnq�`��
APPLICANT INFORMATION
Check any that apply: Change of ownership of use Change of name New business
(Change
Business Name /Type: '[ 1� C�8 �f � r&f ? C4u r S {G IM Cby0A(24%1
Previous Business on this site, 9W e
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: �rctft% � 13�� s,,
a JrA%f Qec CM I O nt
*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 1 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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed C�C(+ l..C,t' ss I
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 �, � o Date 2. (i `t I ky
t
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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8 x 10'
Private Office
8' x f8,—
Main Office
360Y
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Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
11 Engineer's Report (CER) packet.
Y/N
Will there be food preparation?
If so, give applicant a Health Department form.
- - - -- - -= Zoning= review - can - not --begirLuntiLwe--receive=approval= from =Heal
Dept. FAX DATE
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
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 pen-nit.
Permit # Inspector : Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
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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