HomeMy WebLinkAboutCLE201000110 Review Comments Zoning Clearance 2010-06-28Application for Zoning Clearance
CLE # 2610-q(0
I %RCIN�T
❑ Zoning Clearance = $35
OFFICE USE ONLY
Check # /5qt Date: e-1-1()
PLEASE REVIEW ALL 3 SHEETS
Receipt Staff. .,r-r-15
PARCEL INFORMATION
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Tax Map and Parcel: Existing Zoning h+►
Parcel Owner: Clk i'e� L•'4-c-
ParcelAddress:��� ►`� Cit ��cCZ1. VU�l9tate lids" Zil _
(include suite or floor)
PRIMARY CONTACT A �� ,! ' t
Lt'��I�i��,(zw �
Who should we call/write concerning this project? CIOyjw
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Address :AOJ, IT4+( (_ CityC4W1LP' TWVA tCState ZipiL n
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Office Phone: ✓ fA Cell 4j� ( j%' ')'.'�'ax # � C(.4 E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: S �e� P A LVC j f �U (-M(Z S �Ly S L L_ C IWL �1''
/I
Previous &4ke-�'
Previous Business on this site C.�
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
vehicles, and any additional f formation that ou can provide: O� JltiwSIGA<<Pvi N.1�t14�w+dtrl
1- b k= L S— .� J.1 TL
Sq E 4
*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, anew 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 a curate to the best of my I i ledge. I lave read th i[ians of approval, and I understand them, and that I will abide by them.
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Signature Printedl k W .► C� Roy -,m t/
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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 (,f�J r
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:
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.
91N
rmitted as:
Y /N
Will there be food preparation?
Under Section: 2-Y,70 (91
If so, give applicant a Health Department form.
SP's:
YZ)
If so, List:
Zoning review can not begin- until- we receive-approval -from Health ----
Supplementary regulations- section: -- - -- --- - - - - --
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or ubl7aitmcnt r?
Parking formula:
If private well, provide He a D form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Required spaces: n
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or
Y/N
W'11 b tt 4 f 1 ' d9 If bt
am
i you e pu mg up a new sign o any an so, o proper
Sign permit.
Permit #
Y /Otiere
Wil be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to rmmnlPtP the fnllnwina-
Inspector
Notes:
Date:
Violations:
YU /N
If so, List: //
Prof rs:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
YZ)
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3