HomeMy WebLinkAboutCLE201000068 Review Comments Zoning Clearance 2010-05-13Applicati ®n for Z®nin ,�learance
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Zoning Clearance = $35
PLEA E REVIEW ALL 3,.SI3E TS
OFFICE USE ONLY cql.,
Check # Date: /
Receipt # Staf'f:
PARCEL INFORMATION
Tax Map and Parcel: ' 1 ''g Existing Zoning /" y
Parcel Owner:
c o C�
Parcel Address: qAP, % h ACiity� Mate Zip
(inclu a suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 1;(Vrr"_V
Address : 9S� l C.?L �� CityGL�G.GC/V ate lo` 4 Zi C
1516
( ) �' / well #��D ?0�-
Office Phone: Fax # E -mail 4114 -T
APPLICANT INFORMATION
Check any that apply: Change off Change of use Change of name New business
ownership
Business Name /Type:
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: 0 re ce c �
*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 c i y tl own r h Rvylkonowledge. wner's permission to use the space indicated on this application. I also certify that the information provided
is rue nd a rate to t est I have rea onditions of approval, and I understand them, and that I will abide by them.
i n•e Printed .6Qual'see-
A ROVAL 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 1 a �--� Date 4 / � t 1 o�
Zoning Official Date�/�r''
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: t
Is u0i LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. 6/ N n(�
Permitted as:�}Yyi�•�1�`tY
Y/
Will j e be food preparation? Under Section:
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 private well orRebHelme
If private well, provide He th Depart t form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Circle the one that appl Items to be verified in the field:
Is parcel on septic o public se r
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
'- N
Will there be any new construction or renovations?
If so, obtain the roper Permit.
Permit # Ta " g 2--5
Znnino to emmnlete the following:
Inspector Date:
Notes:
Viola o
Y/0 ns:
If so, List:
Proffers:
Y/�
If so, ist:
Variance:
Y/
If so, List:
SP's:
Y/
If so, ist:
Clearances;-----..
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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