HomeMy WebLinkAboutCLE201000137 Review Comments Zoning Clearance 2010-07-12l
Application f ®r Zoning Clearance
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CLE # i d — /,S
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EO Zoning Clearance = $35
OFFICE USE QNLY f yr
Check # SZ Date: z V
PLEASE REVIEW ALL 3 SHEETS
Receipt # 461,f Staff: dfilkyu
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
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Parcel Owner: CIO 6e dny'ell)' en-� P /Cd/I'v2x+5 /riG Ca4 -e,r),�
Parcel Address: -2500 I7uS fl N bR 1 V6 City C Aarlo -HeS Pflle State Zip 4a7 F /I
(include suite or floor)
PRIMARY CONTACT —
Who should we call /write concerning this project? {-64
Address: .25'1 &rep �1Gt l l e y / a r �GN� / City M,Fj _ V 2rr, State �� Zip 1905
Office Phone: �� � d a ( Cell # �5Fax # 610 4V ? E -mail t irleU e ✓UGkep, Obm
APPLICANT INFORMATION
Check any that apply: Change of ownership
Change of use Change.of name New business
Business Name /Type: 69d Se rVI G 2
P g
Previous Business on this site e ltep-�- ; ,r, %(r= ,iYV 16e /D V i er 5:
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 pf ovide: _ ��er-a�ed p 1 &fe'' CGfe�eri r1,.
,j empioyee-5. ajie,f /x/2!161,1 70 /1 C'OmNGCh� Vc°l>>'c C'S an S, 0
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew 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 accurate the
of nowledge. I have read the conditions of approval, and I understand them,, and that I will abide by them.
�to' �best
Signature
(° �,'S[�vw0 Printed
APPROVAL INFORMATION
,,[,s] 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 Z
Zoning Official 44 Date Z/1 /cam
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: I Reviewer to complete the following:
Is/
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N L1 j�
Will there be food preparation? �(%( /
If so, give applicant a Health Department form.
Zoning review can not be in until we receive approval from Health
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Dept. FAX DATE it1 -�-
pp
Circle the one that applies 1 ti Q ecr A i,V, .,* GIG&
-- -� ---�•
Is parcel on private well rpublic water?
If private well, provide Health IIepaFtan form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli s---- —�
Is parcel on septic o ublic sewer? '
Y /N�
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wih5ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Square footage of Use:
/N
•miffed as: gam, r4 'W -r J ( d''
Under Section:
Supplementary regulations section:
Parking formula ---- ''�j
Required spaces:° °— ""� —
It
IternVo be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/67
If so, List:
Proff s:
Y / /1G�
If sb; List:
Vari nce:
Y/v
If so, List:
P's:
/N
Ysa, List:
Clearances: _ ... _�
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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