HomeMy WebLinkAboutCLE201000103 Review Comments Zoning Clearance 2010-06-02Application for Z®nin Clearance
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CLE # ''
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OFFICE USE ONL
Date:
Zoning Clearance = $35
PLEA REVIEW ALL 3 SHEETS
Check #
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 45C -02--i Existing Zoning
Parcel Owner: 4m l MPe(I�A 0-C
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Parcel Address: i t "�d �/1��� �PSn:nUli� TCrn� City State �(�I ZipZ l 0 1
(Include suite or floor)
PRIMARY CONTACT
1)
Who should we call /write concerning this project? roq
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Address: 9,0-? o Ko � City 1��i1 `� State Zip 'zV01
Office Phone: ( 14) I l V "o Cell #04 44 qVM Fax #434913 10(e A E -mail +o , c (ews oo- i Co o-
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APPLICANT INFORMATION
Check any that apply: Change of ownership of use Change of name X New business
Change
Business Name /Type: '.py,,nn � 90 V I — R ti6 A
Previous Business on this site yowx tz' ,ye,
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: 5,kk�
*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 tl best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
/
Signature Printed l ft,v.r5
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 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:
Y /:
Is us'e7in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /&
Will there 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 well or (public water?
If private well, provide Healt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that aLhe
Is par cel on septic o ic sewer?
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 #
znnina to rmmnlPtP the fnllnwinu:
Reviewer to complete the following:
Square footage of Use: J '2-1,)--
N
Pemi`tlted as:�r
Under Section: y 5`' • /
Supplementary regulations section:
Parking formula:
IN c'I
Required spaces:
Y/
Items to be verified in the field:
Inspector•
Notes:
Date:
lations:
N
If so, List:
)
Prof rs:
Y/
If so, ist:
Varia ce:
IfJ
If /s/, List:
�S�,OsList:
Clearances:
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SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3