HomeMy WebLinkAboutCLE201000194 Review Comments Zoning Clearance 2010-10-15Application for Z®n� in
CLE # Clearance
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ing Clearance = $35
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OFFICE USE ONLY k
Check # L5 -fa / Date: _ `G ��U
PLEA ALL 3 SHEETS
Receipt # Q 6 Staff:
PARCEL_ INFORMATION _ -
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Tax Map and Parcel: � JA ^' y� � f � � �� 1 � � Existing Zoning i
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Parcel Owner: <Sa),o
Parcel Address: /d Ctt�� City eNi�4�Os(�qC tate Vl7 —Zip I
(include suite or floor) 2C7
PRIMARY CONTACT �-- )
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Who should we call /write concerning this project? �J / Q AJ
Address: 10q -4, MJ L�A AA/197 City AC{-b.At(\ & State VP" Zip 23WS
Office Phone: 46 - -O Cell # 399`9Z (ii Fax # _7��- (Jel E -mail -Je! . jz e_! o q 1e4oASV_Ef.
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _ -New business
BusinessName/Type: T INN
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Previous Business on this site �J
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:
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*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 th owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurafkto the best of y owledge. I have read the conditions of approval,, and I understand them, and that I will abide by them.
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Signature Printed J
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, xl 17.
[ ] 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 1 0-`il r a
Zoning Official , G' s; 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:
Y / N
Reviewer to complete the following•
Square footage of Use: [ u
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
N
9ermitted ku)
Y/N
as:
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:
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Requi d spaces:
Dept. FAX DATE
Y/IN)
Circle the one that applies
Item o be verified in the field:
Is parcel on septic or 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 #
Zoning to comDlete the followinLy:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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