HomeMy WebLinkAboutCLE201000105 Review Comments Zoning Clearance 2010-06-01Application f ®r Zoning Clearance
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CLE # 2016 _ 105
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Zoning Clearance = $35
OFFICE USE ON 1,Y
Check # 14L94 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # % 1 Staff: �!(
PARCEL INFORMATION -
0 If 00 00 d Q 0306 + DM
Tax Map and Parcel: Existing Zoning
Parcel Owner: 6 ()QA PfpAt4j$5 LLC
Parcel Address: 601D PCRY 5eRCVW Pkwy City C6-Akollf, State VA_ Zip Zl'g�I
(include suite or floor) 3 ��
PRIMARY CONTACT ' } a ( N da,
Who should we call /write concerning this project? `� V V1l�iGi.l� a, i V ii�,
Address: �Vrj i w , *w City UJ1V1111kf\A11'Pi State V Zip 22_q 1
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Office Phone: hhq1j D OZi Cell # R)4 p Fax # 4 3 q g7C*Xql E -mail a (Vl AIja 04kr.GC6t er
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APPLICANT INFORMATION
Check any that apply: >t Change of ownership Change of of name New business
(us�e� L (JChange
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Business Name /Type: r oel
Previous Business on this site 1 M (' V l D 6N., 44 q S 1 J 4_S
Describe the proposed business including use, number of employees, numbe of shifts available parkin spaces, number of
vehicles, and any additional information that you can provide: M4,11 Od %C �. 9 Zwla 4�t ��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 ac to �e b t of kno edge. I have read the conditions of approval, and I understand them, and I will abide by them.
Hrat nthat
Signature Printed Ho N 1 T rT No phi M
APPROVAL INFORMATION
[/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
Zoning Official 6 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 / _ Square footage of Use: ? C(
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. 6/ N ('
Permitted as: N` , 1' /S JAI 01-1
Y
Wi sere be food preparation? Under Section: '� . A • '� „
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 w�tei Parking formula: /
Is parcel on private well prr public ?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y I�1'
Circle the one that ap 1.i�s`' Items-to be verified in the field:
Is parcel on septic otpublic s±yexv
Y/N
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to e.mmnlete the fnllnwinu:
Inspector:
Notes:
Date:
ViolaY ns:
Y /
If so, ist:
Proffers:
N
so, List: 0-15
Variance:
Y/
If s ist:
SP's:
Y/
If so, ist:
Clearances: /
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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