HomeMy WebLinkAboutCLE201000098 Review Comments Zoning Clearance 2010-05-21Cfl2!-
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Application f ®r Z®nin Clearance
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CLE # /6 "
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Zoning Clearance = $35
OFFICE USE ON Y r ]D
Check # Date:
Receipt # Staff: J DUJIU
PLEAS REVIEW ALL 3 SHEETS
PARCEL INFORMATION
Tax Map and Parcel: i 6 � �(`QC� Existing Zoning
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Parcel Owner:
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Parcel Address: % V 41_kV11K4e City State Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: `Z D s L' /l4 , hT(7 1 G City 9 Ar j cf5b r b� State y A- Zip 122 9
Office Phone: Clift ,5 L Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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$usiness Name /Type: LA -1' e,
Previous Business on this sitolp AP 43=)e /'-t A, r
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: / .GelAM -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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �/� �Y'Yi��D Printed
APPROVAL INFORMATION
,[,4�1 Approved as proposed [ ] 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 determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date TIC
..,� lip / l
Zoning Official L Date
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:
Is/
Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
N
Il there 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 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/N
Circle the one that applies Items to be verified in the field:
Is parcel on septic or public sewer?
Y/@
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/
Will Cre be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7oninu to complete the following:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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