HomeMy WebLinkAboutCLE201000052 Review Comments Zoning Clearance 2010-06-25•v
Application for Zoning Clearance
CLE # Z b i b - S
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Zoning Clearance = $35
OFFICE USE ONLY , L
Check # 1 z, Date:
Receipt # Staff: 07M
PLEASE REVIEW ALL 3 SHEETS
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PARCEL INFORMATION
Tax Map and Parcel: 0101 WO "o I -OA- CO-TAP Existing Zoning COMW eA ack
Parcel Owner: %/lAA P- L • L . G. r 4 „ e fti
C_J 5ul1es w , v 1
Parcel Address:Z510 ReV'sen" c. CityNA2,oe iI1 e State VAr - ZipoZ_ 1
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? (6(5;=L W - IZaV . 02 d
Address : 6qo Sc-lZio I-mb cAizcI,F CityC Q0P(a .0T1_6SV1J It. State VrA Zip 22.qol
Office Phone: () 61-18' (I It b Cell # 0342413Sa1 -1 Fax # q34cn3011 g E -mail geol''A
SIm a0Ts ALeonIIrw- • Ctsr-,
APPLICANT INFORMATION
Check any that apply:: Change of ownership Change use Change of name -"New business
_
-o'f,� -
Business Name /Type: IVO(Lli}j26 R GRummom NAm �U�S TA :eRnlUIUY�k
Previous Business on this site 1�N]6
Describe the proposed business including use, number of employees number of shifts, available parking spaces, number of
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to
vehicles, and any additional information that you can provide: �t�`t 6 em S r-1
SIB V°LnnC, v — ntlys i't&�nJI5 s, stiDno2i
*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 her y 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 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 G OMG i W . (ZW, . SQL 3 2 to
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 ; c.°•- - Dated i
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: r "l 17
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. N
ennitted as: Al
Wilere be food preparation? Under Section: 92 -d'
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health = Supplementary regawl 4ions section: - -_
Dept. FAX DATE 1'V 1.
Circle the one that applies Parking fonnula:
Is parcel on private well or ublic Ovate D)
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health Required spaces: /�,i
Dept. FAX DATE `� 1
Circle the one that applies
Is parcel on septic o ublic sewer
0 N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
�YY N SPe, bCU"
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # lo�l T 1$
sP� �,.
7nninv to emmnlete the fnllnwin¢-
Y/N
Items to be verified ' le field:
U
Inspector:
Notes:
Date:
Violati ns:
Y /
If sl ,List:
Proffers:
Y /
If so, List:
Van nce:
Y /N
If so, A:
SP's:
Y /
If so, rst:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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