HomeMy WebLinkAboutCLE201000090 Review Comments Zoning Clearance 2010-05-20cAu,
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Application for Z®n'ng Clearance
CLE # 2016' e6
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Zoning Clearance = $35
OFFICE USE ON Y <
Check # a Date: /U
PLEASE REVIEW ALL 3 SHEETS
Receipt # , I Staff: 41 kVffXJ
PARCEL INFORMATION
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Tax Map and Parcel: I Existing Zoning
Parcel Owner: �� �S % ✓ ( i
Parcel Address: b t7. Age)- 0) City / I 0 11 vl zte V Zip
(include suite or floor
PRIMARY CONTACT �v C L,�-(
Who should we call /write concerrningg this project?
Address :T Z�(i1�nJ� 1 �[ City QPS� WeState A Zip
Office Phone: Cell # I I ? I O ax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type:
I-
Previous Business on this site 1 V l h t O h�
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional rinformati n that you can provide: 3 euatnluu�¢� 5 , 1 5(n� % . (1 u► wtt**V01 D ar 11't�a
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*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 he best of my knowle ge: I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
[V] Approved as proposed [ ] Approved with conditions [ ] Denied
"[ ] Bacl&ow 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 ( Cl)
v
Zoning Official Date
Other Official y 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/
Is use n LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review cannot begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or If private well, provide Hepartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p4blic sewer?
W44-you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # -010-77
V I N
11 there be any new construction or renovations?
If so, obtain le oper�?�t.
Permit # t
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
IN I /
Permitted as: e !�.
Under Section:�"��1 �-
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
�1 /N
If so List:
`` /` ))
ffers:
Y/N
f so List:
Varia ce:
If
Ifs ist:
P's:
/N
If so, List:
y�J �—.S%
Clearances:
SDP's
%C3 "�
ri /J` ✓fit.
Revised 04/28/08, 10/13/09 Page 3 of 3
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