HomeMy WebLinkAboutCLE201000184 Review Comments Zoning Clearance 2010-09-13P
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Application for r7o *ngr Clearance
CLE #
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Zoning Clearance = 835
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OFFICE USE LY /j
Check # Date: q'Id JIM
PLEA REVIEW ALL 3
Receipt # Staff:
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Tax Map and Parcel: 751- Existing Zoning
Parcel Address: ` 10 �ern�nr��e jrQi/ City L740r %a�# Vi� %State_ V }
Zip c�r� g/
(include suite or floor) -lu /0/" /O x v /0,3
PRIMARY CONTACT
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Who should we callAvrite concerning this project? —✓B strP �i n 5
Address: 10S' City 67n v,'Ile State "
Zip '2;Z 9
Office Phone: L`} Cell # 16.2 -�101S Fax #. ,a2 T.• 4, 9F E-mail CictZQ�tl�3
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APPLICANT INFORMATION
Check any that apply:-_ - Change of ownership Change of use Change of name _ New business
Business Name/Type- &Pk1 P a ifi /eP G! t^ d? m 7L'
Previous Business on this site 7n . L 17 o(!a n I& 54-iz u h a h t
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: -/ 't „- ca r
*This Clearance will only be valid on the parcel for which it is approved. Ifyou change, intensify or move the use to a new location, anew Zoning
Clearance will be required.
I hereby certify that oti' or have the owner's permission to use the spaceindicated on this application. I also certify that the information provided
is true and aocurat o e best of my knowledge, I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature - -_ Printed JO."it I'v q" 11 - n/X—g
APPROVAL INFORMATION
�Approved as proposed [ } Approved with conditions ( ] Denied
C } Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117,
[ J 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,
Building Official
Zoning Official
Other Official
Date C C)
_ Date D
Date
County f 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:
Y /
Square footage of Use: 3 y�
v
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Q/N
&21 N
Permitted as:
1/11 there be food preparation?
Under Section: Z J
If so, give applicant a Health Department form.
Zoning review - can not-begin-until-we receive approval =from Health =
Supplementary - regulations - section : = - - -- - --
Dept. FAX DATE
Variance:
Y-
If s ,List:
Circle the one that applies
Is parcel on private well o ublic water?
Parking formula: (�
Uvb
If private well, provide Hea epartmen TM.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/
Circle the one that ap 1'
Items to be verified in the field:
Is parcel on septic o public sewer?
Clearances:
Y/
Will e putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
1, /Notes:
Pere
Will be any new construction or renovations?
If so, obtain the proper Permit.
Permit #'
7nninu to emmrilPtP tbP fnllnwin¢:
_Volations:
/N
If so, List: A
n
Proffers:
Y/
Ifs ist:
Variance:
Y-
If s ,List:
's:
/ N
If so, List: �� ✓ 2�
Clearances:
SDP's
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Revised 04/28/081 10/13709 Page 3 -of 3
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