HomeMy WebLinkAboutCLE201000083 Review Comments Zoning Clearance 2010-05-27C
Application f ®r Zoning Clearance
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CLE #
Zoning Clearance = $35
OFFICE USE O LY i�
Check # Date: CV
PLEA REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Parcel: (�(7 ���Ud (� ' Existing Zoning �—..
Tax Map and
Parcel Owner: y� �``__& / �!
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Parcel Address: Zo 1 J A V�inoA Cfoo L (a (City a0grj4+ (?`�C�f ` State 1/ A Zip29
(include suite or floor)
PRIMARY CONTACT
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Who slio uld we call /write concerniiig tliis project? a V1 n 0 ✓\ � C -u
Address: )0 {RMJLQ, 3,1) ��80
�� iitV Q, City 0r6 State VA zip =/80
Office hone: Cell # �I34 -- 244- Fax # E -mail
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APPLICANT INFORMAT N
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 1--pops , —' C01r 1D GYr �'J O ✓1
Previous Business on this site
Describe the proposed business including use, number of employ „eel, number of shifts, available parking spaces, number of
W�,1<441 '(A
vehicles, and any additional information that you can provide: Gv1et ( 1 CQr; -Grt
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*This Clearance will only be valid on the pa •cel for which it is approved. If you change, intensify or move the use to anew location, anew Zoning
Clearance will be required.
I hereby certify that I own or have the owner's pennission 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 DA VIyyQ'V •iifLC� — Printed S h o 1/) rl oyl I 1 1 CX .
APPROVAL 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 Date
Zoning Official ,, Date ��(J
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/I
Is use m I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will tlYere 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 we 1 or public w er?
If private well, provide partment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap lies
Is parcel on septi or public sew r?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y �there Wil be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Aiini ted as: �r��C�. 17 3 °'y
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:_
Y/
Item to be verified in the field:
Inspector:
Notes:
Date:
Violations:
y/
Ifs st:
Proffers:
Y/N
If so, List: �� � l � �• � 2�
Vari ce:
Y/
If so, ist:
SP's�:
Y /S)
If so, List:
Clearances:
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SDP's
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t - -/
01 —7
o 7 — 273
Revised 04/28/08, 10/13/09 Page 3 of 3
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