HomeMy WebLinkAboutCLE201000078 Review Comments Zoning Clearance 2010-05-13Applicati ®n f ®r Z®nin Clearance
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® Zoning Clearance = $35
OFFICE USE ONLY /
Check # 2 5 0 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff-
PARCEL INFORMATION ?!
b(�IU D "�/ / " X3 66 Existing Zoning // l
Tax Map and Parcel:
Parcel Owner:
Parcel Address: 7\C)() ���w�GsS' y� City State ~ `v�~G Zip Z2RQ�
(include suite or floor)
PRIMARY CONTACT o
Who should we call /write concerning this project? CArC-%d
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Address : ` -= Cn&3 y-`t City t! y �` tate 1 `c Zip xio k
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Office Phone: '7`rj2Ce11 #�i�3Fax #�Q',�1���2E -mail `G�� ti USA �lSe
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: �_)t\k\1_ �S94 VZ3 10A 6_jcr tiles_
Previous Business on this site ` y-
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: �.iSCe,cv�art�cC�c�c�YL°S .,
*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 re best of myk9owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Printed
Signature
APPROVAL INFORMATION
[ ] Approved as proposed L,#,OJ Approved with conditions [ ] Denied
[ ] Bacicflow 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 detennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date, py� l` /
5�t /��
Notes: lgis 6411 AJ)
Building Official c Date fit) k.
Zoning Official Date ��3�� 0%,6
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:
Y/N
Is use in LI, M or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will ptiere 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 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 septic o public sewer?
Y /0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to rmmnlPtP the fnllnwinor-
Reviewer to complete the following:
Square footage of Use: x, L-1.) J
N ted as: I
er/ t
Under Section: �-L W . 2^
Supplementary regulations section:
�- _Ly/ of X , �U �• / � 2.v
Parking formula:
Required Required spaces:
Ite o be verified in the field..
Inspector : Date:
Notes:
Viol tions:
Y/
Ifs ,List:
Proffers:
Y/
If so, t:
Vari e:
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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