HomeMy WebLinkAboutCLE201000187 Review Comments Zoning Clearance 2010-09-17Applicati ®n f ®r Zoning Clearance
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CLE #�
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Zoning Clearance = $35
OFFICE USE ONLY
Check # . . r Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 7 Staff: jn
PARCEL INFORMATION
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Tax Map and Parcel: Existing Zoning
Ag ("
Parcel Owner: {'
Parcel Address: l � V � (lbw I&I-ity 1?10 1/11Q) i9 (: State Vfi-Zi2
(include suite or floor)
PRIMARY CONTACT Lr
Who should we call /write concerning this project?
Address: N44' 04 b --V 5�a.c.c. City �'��d� State Zip `J i
Office Phone: �o( Vii) 0'' �%-6`? Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 5 ��- o l• B if �ts��
Previous Business on this site
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:
*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 best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �u Printed ';ab te-1- L. 4-4,t.c
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 I ( -I ( 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:
I Y /(� Square footage of Use: �- ` Dub
Is useZnJ�I, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. -0 / N
/'� Permitted as: r CAA I
Y
/f pp
Will e be food preparation? Under Section: �� • Z-- l
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
Is parcel on private well ortubl is water?
If private well, provide He t form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic pu sewer.
Y/
Will u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will �e any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Parking formula:
Required spaces:
lt
lterho be verified in the field:
Inspector :
Notes:
Date:
Vio ons:
Y/
If so, ist:
Proff rs:
Y/
If so``,,ist:
Variiaa�nce:
If sb, List: ��so,
SP's:
List: J
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3