HomeMy WebLinkAboutCLE201000062 Review Comments Zoning Clearance 2010-04-12P1
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Applicati ®n f ®r Zoning Clearance
CLE # � Of a L
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F Zoning Clearance = $35
OFFICE USE ONLY
Check # q -710 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 60 a U 00 00?/10 (1) Existing Zoning / i4
Parcel Owner: �%7 C�l� �6� G'��I G / �ff�� �% c-'
Parcel Address: 22�� , / -J(v- t`i h01-_`aJ'�ra 1S tae Vl�_ Zip z70,s
(include suite or floor)
PRIMARY CONTACT
Who sliould we call /write concerning tliis project?
Address: Fof U 16--J, �_?b City Uer joke sd,lle— State IC A. Zip 27 ,113
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Office Phone: 3q _'Zfj -`1Y4) j Cell # Fax # _q*) zj3ry E -mail
c te) k
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: ro)onz (A )?,qe.i
Previous Business on this site
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: Aoi 5.e_
*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 knowledge. I have read the conditions of approval, and I understand them, and thattII will abide by them.
Signature /'`irk Printed 1D
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 Date
Zoning Official Date��J /[i
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 /
Square footage of Use:
Is us In LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
OIN
qilll N there be food preparation?
rmitted as: &1A KA e-e
Under Section: SP %-7
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 formula:
Is parcel on Rrivate 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/
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y /O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / 0
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninsr to emmrilete the fnllnwinu:
Violations:
Y/
If so,Z ist:
Proffers:
Y/
If so, List:
Variance:
y/
If so, ist:
SP's:
Y/N
If so, List:
991) -A)
Clearances:
SDP's ---------�
Revised 04/28/08, 10/13/09 Page 3 of 3
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