HomeMy WebLinkAboutCLE201000111 Review Comments Zoning Clearance 2010-06-23Application for Zoning Clearance
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231zoning Clearance = $35
OFFICE USE ONLY
Check # ( ``i t>9 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt #_ 7�Dyb Staff: ; LJ
PARCEL INFORMATION / f P
Tax Map and Parcel: (c2171�� I arrd^�!� o i I Existing Zoning ��
L?ar)
Parcel Owner:
pp pn
Parcel Address: SSS rid J� City chii &I (� Sy` kl State Zip - -I
(include suite or floor)
PRIMARY CONTACT ( `
Who should we call /write concerning this project? r@, kr^ 1 c,
Address : �a(; RA - &kj�e City O L A,{ esi), 1( State J -)A Zip
L X0313
� S -L # E -mail
Office Phone: " 5 4./ell # Z
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: 'T 0-6m it Er c ,c- d e. r, ('act Se v u 1 c-es LLC µ --iPCi r 1 L-) a
Previous Business on this site ,,c
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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�' �2 lqn ;free' =� -�? c f .,, �) t, C es-
*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 Zoni ig
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 l n I1-r iS C .J l lS
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 (( ( 0
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
C-C
Intake to complete the following:
Reviewer to complete the following:
Y /N
Square footage of Use: 2 U
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
N t
Y/ 1�
Will there be food preparation?
ermitted as: Guy i ,•.� .� .�v �-�
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: 4
y
bli
Is parcel on private well o uc wat .
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If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y N
Circle the one that applies
Is parcel on septic or blic se ?
Ite o be verified in the field:
Y/N
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y /�
Notes:
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Viola
Y/cv ns:
If so, List:
Pro
Y/W s:
If so, List:
Vari e:
Y/
If so, List:
SP'sf�
Y
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3