HomeMy WebLinkAboutCLE201000146 Review Comments Zoning Clearance 2010-07-28Application for ZonI* Clearance
1
CLE # I — 1 L
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ning Clearance = $35
OFFICE USE -ONLY -7J ` tld
Check # 11 G Date: J
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: TD11 (rd,
PARCEL !
INFORMATION 1�' -
`
Zoning
Tax Map and Parcel: JAA "1 p `�' Existing
Parcel Owner:
4j State Zip�,�r�
Parcel Address: Jjridj City `�
(include suite or floor)
PRIMARY CONTACT CA J �—
0309
Who should we call /write concerning this project?
�./1' �t �.f'� CI ' City State A Zi
Address _�+�
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Offlce Phone• -/ ��'� � Cell # • e 7 -0N Fax # E -mail cg
APPLICANT INFORMATION
Check any that apply: Change Change`of use Change of name New business
^offownership
-;Ea
Business Name/Type:
Previous Business on this site .4)14
Describe the proposed business including use, number of employees, number of shifts, available par mg ,paces number of
�W c4 : ° Y.
vehicle, a fd. any additional inf rmation that you can provide- )i-ji�CtA%� i'Ja"I
C✓I'M - U -0 (-e f 1'h C I
C C1 ls'l0"A
*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 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 p1the best of my know e e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature 4 Printed V '
APPROVAL INFORMATION
as proposed [ ] Approved with conditions [ ] Denied
�[/JrApproved
[ ] 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 D t m
Zoning Official Date
Other Official Date
County of Albemarle Department of Community vevempinent
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- in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. _ / N
Oermitted as: 4A,1 OVj
Y
Will there be food preparation? Under Section: ��
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 / Q
Is parcel on private well or fib ' e .
If private well, provide Heal{ ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic -or p Ir �c_
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 14/04-
ffu
Parking
i0u-
Parking formula:
Required spaces: L
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
& N
If so, List:
P ffers:
X11 N
f so, List:
Variance:
-0 /N
If so, List:
SP's:
Yi2t:
If
Clearances:
o
SDP's
CTSi-' 7-0 y
6 2 /2'y
Revised 04/28/08, 10/13/09 Page 3 of 3
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