HomeMy WebLinkAboutCLE201000138 Review Comments Zoning Clearance 2010-09-24Application f ®r Zoning Clearance
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CLE # D/ a -13
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[� Zoning Clearance = $35
OFFICE USE ONLY
Checic # 3a h 3-L- Date: �" fZ-/D
PLEASE REVIEW ALL 3 SHEETS
Receipt # T y� Staff:
-- -YA-R- GEL - 1NF0RMA =T- O -- - _ _ _
—�"C�D 38p existing Zoning
Tax Map and Parcel:
Parcel Owner:
Parcel Address: City State Zip
(include Suite or floor)
PRIMARY CONTACT
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1N111 o should we call/write concerning this 1) r lam
-�oject?
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Address : a5aO bea� n U7SiY\� City dW e 1 State I] a Zipa2' to
Office Phone: (q&4) �t-i� Cell # jq t-1 o-,� Fax # �J E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:'
Previous Business oil this site �T a-,e—o,,4 --
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: U \4' z a!, C-V\:,ka(e,- S
r Nn A v-2h L n� <ecA
*This Clearanc ill 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 II'Lle and accurate to the best of my knowledge. I have read the conditions of approval, and I understand that I will abide by them.
nfhem,1and
Signature Printed 0 a lk,' f\ &—XIV �ell
AP 'ROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Bacicflow prevention device and /or current test data needed for this site. Contact ACSA, 977 - 45111 xl 17.
[ ] 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 i ( I t
Zoning Official Date T�2�/
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:
Y/N
Is use uI L1, H1 or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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Will there be food preparation?
-lfs� give- app "licah� -a= Health= Department= fo��n. - -
Zoning review can not begin until we receive approval from Health
De it FAX DATE
Reviewer to complete the followhig:
Square footage of Use:
/N
ermitted as: I•- AA, 1
Under Section: '�-5.,A, A. -,7•
Supplementary regulations section:
I.
Circle the one that applies Parking formula:,f
is parcel on private well o> >ubli ater? �• �/�
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y rN
Circle the one that applie Items o be verified in the field:
Is parcel on septic or ublic wer?
Y N
I you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Z
Permit 01 o— �
�3� Inspector : Date:
Y / N Notes:
ill there be any new construction or renovations?
If so, obtain4e proper Permit.
Permit # Z-010-1 00 it
uV Yplations: v
y) /N
so, List; A P rA _ , R q
roffers:
Y/N
If so, List:
Va •► ce:
Y/
Ifs , ist:
SP's:
(:YjYN
If so, List:
/ l
c
Clearances:
SDP's
oy —id1
6 ey _' r51
Revised 04/28/08, 10/13/09 Page 3 of 3