HomeMy WebLinkAboutCLE201000148 Review Comments Zoning Clearance 2010-07-26Application for Zonin Clearance
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Zoning Clearance = $35
OFFICE USE ON T 2 ,/x
L V Y
Check # %%�65 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # _7q(0 G'5 Staff: ; P/
PARCEL TNFORMATI
Tax Map and Parcel: <f,L1i +"'" C�,�� �� Existing Zoning
Parcel Owner: T uk !a� in
Parcel Address: Z• 13S c_rV rv1• T 1)Q City State Zip 2-2-90
(include suite or floor)
PRIMARY CONTACT j
(®ry \yA5`l 1, 6 LL
Who should we call /write concerning this project? f.G j,
Address: 11E tID 1 ,.fSoCke 'bred'[_ City r.ichl-A°•4 State y Zip�3Z3S
30
Office Phone: ("0 b'iS �zw� Cell # b � l g -q.2_2_ 6 Fax # I,Zx_ zZ - ct E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
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Business Name /Type: 17ae,r�c�S V% c..5 ice_
Previous Business on this site�� SU�Y� -• �1
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: Mt h A 04r i 5 ^',-E �� n 1 10 oc s
G l.tY av-tu y e, Ti JPv 1-T tl7 �OAt.c.\ (�,A �1.0 r, \t.� A� kSAP b•E \4
1 .+ ' M p 1 o dT�V ^s(Y� �- •� .J o J s a W GC. �. i� to L �t �. •L•� ' �'� Qo �'D"✓i 5 D IS r V,% P%� ST S
*This Clearance will only be alid on the parcel for which it is appr ved. If you change, intensify or move the useko 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 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 4ks ,...�:. Printed � Y-,r_&
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 ky
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:
YSquare footage of Use: 1 1 Ci
Is use in LI, HI or PDIP zoning? If so,'give applicant a Certified
Engineer's Report (CER) packet. Y N
lermittedas: / � l i 5 i n.c_, 5 olk Cie.
Y /'�N J
Will ere be food preparation? Under Section: 2 Z
If so, give applicant a Health Department form.
Zoning review cannot begin until. we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies Parking formula: /1-1<j Is parcel on private well or ublic watery d -1-J
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parce on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/O
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Required spaces:
Y/
Items o be verified in the field:
Inspector•
Notes:
Date:
Viola ions:
Y /
If so,gist:
Prof rs:
Y
If so, List:
Variance:
Y/
If so, ist:
SP's:
( /N
If so, List:.
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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