HomeMy WebLinkAboutCLE201000122 Review Comments Zoning Clearance 2010-06-24101,
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Applicati ®n f ®r ZoninLy Clearance
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Zoning Clearance = $35
PLEAShVingEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Q Date:
Receipt # Staff -
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PARCp O TIO
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Tax Ma and Parcel: (� iz Existing Zoning
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Parcel Owner:�2.��r1/�.P
Parcel Address: ,,2/,5-6/a,,'4 Z l%% e%u'i da City t�G7Yd�' Xlleyy�l State 1, 4 Zip 7Z�G�
(include suite or floor)
PRIMARY CONTACT r
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Who should we call /write concerning this project? e,0
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Address : �d /J�}� 633 City ���`y���% /� State Zip
Office Phone: L_) Cell #03'1 -M-b,0 Fax # E -mail i¢/lGr�it%(y✓✓�% 54/ -1,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use _Change of name New business
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Business Name /Type: `IT�iQ�
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Previous Business on this site
Describe the proposed business including use, number of employees, n mber of shifts, available parking spaces, number of
information -ifs 5'� �� l
vehicles, and any additional that you can rovide:i _ ems`
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*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 or h . e the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accur to the b my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
_
Signatur Printed
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�t
Zoning Official `' Date ,(���/ / /)
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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: Reviewer to complete the following:
Y / Square footage of Use:
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N
ermitted as: %; 4 �'� � ✓Y1r"c-
Y/ y
Will tl re be food preparation? Under Section: If so, give applicant a Health Department form.
Zoning review can _n-ot begin until we receive_approyal- from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or pu lic wate .
If private well, provide Health e ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic or ublic sewer?
Parking formula: �/ 2
Required spaces:
Y/
Items to be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7oning to comnlete the following:
Notes:
Violadons:
Y/
If so, List:
Prof ers:
Y/
If so, ist:
Variance:
Y/N
If so, ist:
SP's:
Y /E1
If so, List:
Clearances:
05- �y
SDP's
-
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Revised 04/28/08, 10/13/09 Page 3 of 3