HomeMy WebLinkAboutCLE201000177 Review Comments Zoning Clearance 2010-09-17Application for onin2 Clearance`
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CLE #��
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USE ONLY
OFFICE /� n
Date:
PLEAZoning Clearance = $35
+ REVIEW ALL 3 SHEETS
Check # _,�
Receipt # Staff:
PARCEL INFORMATION
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66 Z6
Tax Map and Parcel: ! • "_ . _ _ _Existing Zoning__
Parcel Owner: a-n
Parcel Address: tJU) I(QA[t WL' & NI City V Ub V I-tate V Pr Zipo p%/
(include suite or floor) ( e�
PRIMARY CONTACT
Who should. we call /write concerning this project? L A U,,(
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Address _ �Q City i State'�?_Zip dUc
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f)Phone:
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: �� 1-- WYYIlpQ,C�lO'1(1S �r�'L. / �OIfY12_ �QGL�T%1 �1(G#aVll
Previous Business on this site i% 0 n l r, � aY1 C
Describe the proposed business including use, number of employe umber of shifts, available parkipg spaces, number of
vehicles, and any additional information that you can provide: !�
In rvrn 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, 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 b st of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed L A6 (A.,
APPMOVAL INFORMATION
[\'Approved as proposed [ ] Approved with conditions [ ] Denied
[ J B flow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ o 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 t o
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:
Y AO
Square footage of Use:
X99
Is use in LI, HI or PDIP zoning? If so; give applicant a Certified
Engineer's Report (CER) packet.
Y / N ^ ��
Will Pere be food preparation?
ermitted as: (}aT
Under Section:
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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_
Parkin ormula: a
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Circle the one that applies
Is parcel on private well or lic wat
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If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that ap
Items to be verified in the field:
Is parcel on septic r public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector :
Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7.nnina to emmrilete the fnllnwinu:
Violations:
Y/N
If so, List:
eftoffers:
Y N
so, List:
�. �-
Variance:
Y/N
If so, List:
's:
Y/N
so, List:
Clearances:
SDP's
evised 04/28/08, 10/13/09 Page 3 of 3
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