HomeMy WebLinkAboutCLE201000204 Review Comments Zoning Clearance 2010-10-13Application for Zoning Clearance
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CLE # 10 �- C� ��
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OFFICE USE -ONLY
Zoning Clearance = $35
Check # v� Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt# RX uQ Staff:
PARCEL INFORMATION
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Tax .Map and Parcel: °' ! L Existing Zoning WL�4 I. Wrn
Parcel Owners -
Parcel Address: ��'a l > w l ya 11.. I � i City G, (� G �1�'SVl I �� State V t-t Zip r
(include suite or floor)
PRIMARY CONTACT f �����
LAr�, 4m\) l +' to -01f
Who should we cal/write concerning this project? 1 aC11
Address . !Q,'C J DN ?K\A)Lj City �i�f(�V(,�[��j�'���ipV �� State VA Zi
Office Phone: � R- Fax# E-mail �0� 10/yw 1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name V New business
Busiuness:Name/Type:
Previous Business on this site
Describe the proposed business including use, number of employees, n tuber of shifts, available parking spaces, number of
information )� FT
vehicles, and any additional that you can provide: ,I1 - _
p4Q),O� 'R, 106 5a P As 4a ZK
fl1A"27,
*T i Clearance will only be laud on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew Zoning
Clearance will be required.
I hereby certify that I own or have the wmer's permission to usethe space indicated on this application. I also certify that the information provided
is true and accurate to to be. of y ' o .l e. T have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature Printed li��l%l P / 4 &&j at j
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APPROVAL INFORMATION
j Approved as proposed [ ] Approved with conditions j ] Denied
;I 13ackElow 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 (o 61 ( o
f
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 -=1126
Revised 04/28108, 10/13/09 Page 2 of 3
Intake -to complete -the-following.
Y /N
Is use in LI, III or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CE R) packet.
YI )
Will``t sere be food preparation?
If so, give applicant a IIealth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle_ the-one-that-applies —__
Is parcel on private well or _-Xi water`
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic o ublic sewer.
CY)/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
V / N
ll there be any new construction or renovations?
If so, obtain the proper Permit
Permit # U 1,5-().g A) v
Zoning to complete the following:
Reviewer ,to- complete the- following
Square footage of Use: 4
YIN
Permitted as:x�c� fVA
Under Section: 2�, • 1
Supplementary regulations section:
Required spaces:
Yl Y
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
YIN
If so, List:
Proffers:
YI&I
If so, List:
X /2Y
If so, List:
91,N
If so, List:
Clearances:
SDP's
6yJys
Revised 04/28/08, 10/13/09 Page 3 of 3
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DAVID FULLER, ALA
MCISTER-mu ARCHITECT
Campbell
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