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HomeMy WebLinkAboutCLE201000199 Review Comments Zoning Clearance 2010-10-06Application for Zoning Clearance CLE # A ©YY) v�6a m ' El/zoning Clearance = $35 OFFICE USE ONLY Check # 9(59�o^ Date: -r'z p - l c) MY.1-- PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: b (0 0 Existing Zoning Parcel Owner: Mes_� A rr Parcel Address: �CTy(Q V S`I`B �CityCh(;V D_ 6 `1State �� ZipZ2"0103 A _ (include sui a or floor) PRIMARY CONTACT f I��p Who should we call /write concerning this project? 1`' IGW ei IY ZS t Address: 9Q,4(p T SUS V-(b City State V N Zip 3 Office Phone: C( -1 -1 - 94(piell # Fax # E -mail APPLICANT INFORMATION Check any that apply: v/ Change of ownership Change of use Change of name New business Business Name /Type: �6�C - t x Ten—Inc. c1BKIIQ U,rne T (_-eA Previous Business on this site 1 V � V1 me 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: Sak- Sic,,-%ue,LA . 2 O�S ?2_6 na yeIA,CleS *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 knows led,,ge.. I have read the conditions of approval,,, and I understand them, and that I will abide by them. Signature Qa A- I��IC. Printed APPROVAL INFORMATION ,/f 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 �J— Date 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 Intake to complete the following: Reviewer to complete the following: Y / N Square footage of Use: Cj cJa Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. 0/ N Y /NO Will there be food preparation? Permitted as: Under Section: J If so, give applicant a Health Department form. - Zoning review =can= not= begin =until-- wereceive approval= from = Health =- =-Supplementary= regulations =section, -_: - -- Dept. FAX DATE -% Circle the one that applies Is parcel on private well o<j ubli ater? Parking formula: If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Required spaces: /f Dept. FAX DATE / Y/ Circle the one that applies Is parcel on septic o ublic wer? Items to be verified in the field: Y /O Will you be putting up a new sign of any land? If so, obtain proper Sign permit. Permit # Inspector : Date: Y /� Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonin¢ to emmnlete the fnllnwin¢: Violations: Y/ If so, t: Proffers: Y/� If so, List: Varfh?T�e: Y /(n) If so, ist: 's: / N If so, List: -% Clearances: SDP's — Revised 04/28/08,-10/13/09 Page 3 -of 3 �> 2