HomeMy WebLinkAboutCLE201000053 Review Comments Zoning Clearance 2010-06-25Application for Zoning Clearance
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❑ Zoning Clearance = $35
Check # Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel Owner: c� G'. °-� �1 Gy2�+ � ti
Parcel Address: - - rj I hru- � A City CVCe -e.� State \/A Zip
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project?
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Address : `� i � `1 lr��� �� -Sr- City C�-r W�VJ ate V A- Zip
Office Plione: ( 11 7-4.8SICell # Fax # E -mail -r" e0 Ve-< 44-0-Ap
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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)V p /-A Akuo L'1
Previous Business on this site rL L*�L{ -�y� �Gl -S+-"6U--u0
Describe the proposed business including use, number of employees, number Ashifts, available parking spaces9q number of
vehicles, a+ any additional information that you can provide:' i� �7 v6 -OfN� 'r aLW--v-- 5a ¢x`
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*This Clearance will only be valid on the parcel for hick 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 accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I abide by them.
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Signature i2�� Printed •
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow prevention device and /or cut rent 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 ( ( 0
Zoning Official 4 Date 6! 72 �
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
Z,
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Intake to complete the following: Reviewer to complete the following:
Y / N Square footage of Use: t
j Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N
ermitted as:
Y d K 1W
Will there be food preparation? Under Section:
If so, give applicant a Health Department form.
Zoning review cannot begin until we receive approval from- Health Supplementary regulations ection:
7nnina to emmrilete the fnllnwin¢:
Violations:
Y/�
If sod, 1st:
Dept. FAX DATE
yy l a
Circle the one that applies
Parking formula:
Va �•nce:
Y �T)
If so, List:
Is parcel on private well public water?
If private well, provide Hea t epartment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
t
Dept. FAX DATE
/
Y/N
Circle the one that applies
Is on septic or ublic sewer.
Items to be verified in the field:
1,& --/,1 Ad
parcel
,, A _�JV-
P
i/N
ll you be putting up a new sign of any kind? If so, obtain proper
Sign Pei i, . I
Permit # ,
Inspector :
Date:
, / N
�
Notes:
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to emmrilete the fnllnwin¢:
Violations:
Y/�
If sod, 1st:
Proffers:
Y /Oom
If solLiist:
Va �•nce:
Y �T)
If so, List:
SP's _.
Y /( N)
If so, ist:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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