HomeMy WebLinkAboutCLE201000056 Review Comments Zoning Clearance 2010-03-31Application for Zoning Clearance
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YZoning Clearance = $35
OFFICE USE ONLY
Check # 57 Date: 43 V
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PLEAW REVIEW ALL 3 SHEETS
Receipt # n I Staff: I
PARCEL INFORMATION ,� p
Tax Map Parcel: is— �`� � lD Existing Zoning �-
and
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Parcel Owner:
Parcel Address: Zip f SOCJ � � t ��
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(include suite or floor) Loo r 1 C
PRIMARY CONTACT `
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Who should we call /write concerning this project? 1'{ 2� ✓I'
Y1�d-pp_S. City State ZipZ 2I
Address
Office Phone: ( TM Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: ~
Previous Business on this site
Describe the proposed business including use, number of employe, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
*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 accurate to the best of my kunowledge. have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed aar`e(i� �, �kz"
A ROVAL INFORMATION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backfow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a deteinination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official er— Date 4- q( Q
Zoning Official Date 4 0
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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 Page 2 of 3
Intake to complete the following:
Is/
Is u i LI, HI or PDIP zoning? If so, give applicant a Certified
Engin e 's Report (CER) pacicet.
Y / Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or ublic water?
If private well, provide Healt 1 epa meat form.
Zoning review can not be i 1 u ltil we receive approval fi•om Health
Dept. FAX DATE
Circle the one that ap )liea
Is parcel on septic o public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Wi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin2 to complete the following:
Reviewer to complete the following:
Square footage of Use: l 10
i) /N
Permitted as: f'1
Under Section.
Supplementary regUlatlions section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Violations:
Y 1V
If so, List:
Proffe /Q:
Y / �I(1
If so7"List:
Variance:
Y /(N)
If so,\\L//ist:
Sp'l.-
Y/
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3
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