HomeMy WebLinkAboutCLE201000096 Review Comments Zoning Clearance 2010-06-28I
Application for Zoning Clelarance
CLE #d
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Zoning Clearance = $35
OFFICE USE O LY D rT
Check #� Date: V
PLEAS REVIEW ALL 3 SHEETS
Receipt # Staff:
`PARCEL INFORMATION-
Tax Map and Parcel: 32-- 3-7A' Existing Zoning
Parcel Owner:' 13 rl S 'rn ar�6�__.
Se id4 ^107 /
Parcel Address: 3 q S'6 Seyn, +-w je —7-�; ( City State VA Zip 229
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project?
Address: City %.� �,i�e_ State V,* Zip Z-2
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Office Phone: U Cell # 60q, E -mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
.SAIBusiness Name /Type: 4 �Cu`I 12 k /1%k ( T C_
Previous Business on this site 5'n,_j e-_'
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:
*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 Printed
APPROVAL IND RMATI, N
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 o Date
Zoning Official / 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
Intake to complete the following:
Y /
Is a in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will sere 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 p blie ?
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 app ie
Is parcel on septic or ublic sewer.
Y /
Will a be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
/N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # to r
Zoning to Mrnnlete the fnllnwina-
Reviewer to complete the following:
Square footage of Use: 1 L3y
0/N
ermitted as: 4PA
Under Section: - 2L.I- •1
Parking formula:
>J
Required spaces l
Y N 7
tems to be verified in the field:
Inspector : Date:
Notes:
0�1
Violations:
01/ N
If so, List:
Proffers:
Y/N
If so, List:
VariiaaNe:
Y1
If so, ist:
SP's:
(2)/N
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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