HomeMy WebLinkAboutCLE201000149 Review Comments Zoning Clearance 2010-08-13Applicati ®n for Zonin`a Clearance
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ZOtllllg CICIII'anCC = $35
PLEA t( REVIEW ALL 3 SHEETS
OFFICE USE ONLY 7,9 tl6
ChCC1C # j Date:
Receipt # Staff':
PARCEL INFORMATION- _
'I ax Map and Parcel: 0C(0"4, (-00-o0 ,-- f7o;`-pc) Existing Zoning
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Parcel Owner: '� eU0i 1 aj±W -Bwj/ICCR A4-t,i Df C�1'�G�j"t!iY' h r[o -eS6 I
Parcel Address: I ��4-1 b i-erYl vt L—n city C bad*esl% Ile state V ek zip22110"
(include suite or floor)
PRIMARY CONTACT
who sllould we call /write concerning this project'? F R C k TJ ea� t-CA-i
Address: -Pit] M (,�Y-" city OvI/xAu rS1%1 state VOA– Zip 22
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Office I'hone: (J�Yb n•1.1'0b9loCell # fax #
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: �m3,�1 �i�c�t
Previous Business oil this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any addit/i�o�njya,l information that you can provide: 4�0 A.4 ti
VvV j 1
*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 infonnation provided
is true and accurate to die best of my I<n ge,17 le read the conditions of approval, and I understand them, and that I will abide by them.
Signature y `'` � Printed CIVi!?f Q-41 P-Qi k bid_
APPROVAL INFORMATION
Xpproved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and /or current test data needed for this site, Contact ACSA, 977 -4511, 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 Ofticial Date
Zoning Official Date
Other' Official Date
County of Albemarle Department of Uoimnun►ty vevetopment
401 McIntire Road Cl►arlottesville, 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 completes thee following:
Y / (T'V Square footage of Use: 6 y
Is uselr:(U, Hl or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. ' / N
Permitted as: f%/ G, (l.S�-
Y / � / j
Will t re be food preparation`? Under Section: ` • /
'lf so give ap "plicaiit= a= HealtlrDepartment -form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies Parking formula:
is parcel on private well of public water.
if private well, provide Hea orm.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
N
Circle the one that applies terns to be verified in tl e field:
Is parcel on septic pu lc sewer. L Al 1i/
Y / ()
Wil l you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
61 N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # b :: —1 2 4 NNE r
r7 1 + 41'n fnll n�aiinn•
Inspector
Notes:
Date:
uvu -
iolations:
/N
If so, List:
Pro s:
Y/ ff
If so, List:
Varlal e:
Y /rd
If so, List:
SP's:
Y/N
If so, List: o
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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