HomeMy WebLinkAboutCLE201000101 Review Comments Zoning Clearance 2010-05-28Applicaii ®n for Zoning Clearance
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CLE # v�Z��b 10 P. -
1
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❑ Zoning Clearance = $35
OFFICE USE ONLY
Check # 79600 Date: �✓�o�b1�'�
PLEASE REVIEW ALL 3 SHEETS
Receipt # t54X Staff:
PARCEL INFORMATION
Tax Map and Parcel: (��I.Jrd D "� "aa — d 5M Existing Zonings c/r�_o 0/1
,dam
Parcel Owner: CA 1.4 �( jj� i i(� G. e, i3 _.d �D ✓��GC ( Au-Am C'L64- �
Parcel Address: 160 //V City4!ILLriF 16 (%J /State - - -- ( - - -Zip.
(mclud suite or floor)
PRIMARY CONTACT /
/write
Who should we call concerning this project?
Address City State l/ Zip,221 52 —
Office Phone: Cell # ,.kS3 /j/VV Fax # E- mail ;AL 01-7p. kTUI ) ea 4),O
APPLICANT INFORMATION
Check any that apply: Change of use Change of name New business
Change of ownershi�p(�
/
Business Name /Type:
Previous Business this ✓
on site
Describe the proposed business including use, number of employees number of shifts available parking spa es, n tuber of
vehicles, and any additional information that you can provide: (�/ U
*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 0 the best of my know ridge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Ljy?
Signatu &'� ll /� �7�€ f ) Printed —A'L_
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 6C/ 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:
Reviewer to complete the following:
Y / N
Square footage of Use: `!!
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified -
Engineer's Report (CER) packet.
Y//V
-
/ N '
ermitted as:
Will 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 o ublic wat ?
Clearances:
If private well, provide Healt rtment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Items to be verified in the field:
Circle the one that applies
Is parcel on septic or ubhc se ?
Y /l)
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / O
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninv to emmniptP 1-hp fnllnwinor-
Viol ns:
Y 'N/
If so, ist:
roffers:
N
f so, List:
Va anice:
Y
If so, st:
SP's:
Y o
If so, ist:
Clearances:
SDP s
Revised 04/28/08, 10/13/09 Page 3 of 3
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