HomeMy WebLinkAboutCLE201000193 Review Comments Zoning Clearance 2010-09-2209/24/2010 01:23 9724310 #3201 P.002/002
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Application for.ZoniU Clearance
CLE #
OF'F'ICE US
E N`
Zoning Clearance - $35 Check # Date:
PLEA 9E REVIEW ALI, 3 SHEETS Receipt #��V4 staff:
PARCEL INFORMATION c� k y
Tax Map and Parcel: Existing Zonln�
Parcel Owner:_ - I V ..... , , - -- . _ ...._ - - -- - - - .. _ .• -
Parcel Address: 0 �/ � State V ZIPC
(include suite or floor)
pEXMAitY CONTACT
Who should we call/write concerning this project? GCS
Address: Jl aln Ga1��y. rt�zJ���� QI City Cr6 State "loot. zipZZ9��-
OtflcePhoae:�3�205- l/O Cell #�O9 "�Or'iF'ax #223 -5177 &man MAONF�'lyi U -C.Cam
APPLICANT MORMATION
Check any that apply: _V Change of ownership _ Change of use Change of name NevY business
Buslnem Name/Typet • 71i r 5o yAliYah 1kF� i.
Previous B'usinass on this site I -er -c5b,•S Gg 'C-
Describe the proposed business including use, number of employees, number of shifts, available parldng spaces, number of
vehicles, and any additional Information that you can provide: 16 potk in p<e i rvo cm del b� ee S
*This Clearance will only be valid on the parcel for which is is.approvad. If you change, intensify or move the use to a newlooador. a new Zoning
Clearance will be required.
I hereby certify that I own or bavo the owner's permission to use the space indicated on this applieati= I also certify rhatThe informationpmvidod
is true and accurate ro the'bst of my lmowledge. I havo rand the conditions of approval, and I understand them, and Char I will abide by them_
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Signature —Printed Zr4SOk r►'F'7,Y,''Sl (�
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Bacvow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] No physical site inspection hag been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
C ] This site complies with the site plan as of this date.
Notes:
Builftag Official Date q t 1.•
zoning Official Date ;% z-- t./41
Other Official Date S IQIAt lb
___ -_ -- _- _- _ - - - - -_
-County of Albemarle )Department of Community Development --
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126
Revised 04/28/06, 10/13/09 page 2 of 3
Intake to complete the following:
Reviewer to complete the following:
Y /0
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Report
-61 N "��
Engineer's (CER) packet.
Permitted as: ..t
✓A
M/ N
1-5
Will there be food preparation?
Under Section: • ,
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
Circle the one that applies -- - -
Parking formula: -
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Is parcel on private well or blic ter?
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If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces.
Dept. FAX DATE
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Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic oblic se ?
e
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/O
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7,oninu to emmrilete the following:
Inspector : Date:
Notes:
Viola ions:
Y/
If so; List:
roffers:
(�j /N
If so, List:
Vari nce:
If so, List:
SP's•
Y/
If so, List:
Clearances:
SDP's
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7
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Revised 04 /28/08, 10/13/09 Page 3 of 3 - - --- - - --
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