HomeMy WebLinkAboutCLE201000214 Review Comments Zoning Clearance 2010-10-21Application for ®nin Clearance
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CLE # 11 (/
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AMVIEW ing Clearance = $35
PLEA ALL 3 SHEETS
OFFICE USE ONLY �/ h n
Check # T Date:
Receipt # Staff:
_JJWtfj�)J
- PARCEL - INFORMATION _ —= r- // -L Ad -t
Tax Map
Parcel: V �J C
and sting Zoning
Parcel Owner:s IfY1m I Cha v V 1 4 cJV mc to s h m S ua r-P,
Parcel Address-1 U 00 ?-10 M • e 41 ZDW City � �iO WM I Gate VA Zip- " '
(include suite or floor)
PRIMARY CONTACT j
�/�
Who /write � (D fC P(m)
should we call concerning this project? � 1
Address: C al 1 YL4 fte City CLIV State 1. 14 Zipg3 I 1
MOM U
Office Phone: 4 4 3 'O�'ACell # quo E -mail m C bit L7l°. biq MS.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use X Change of name New business
Business Name /Type .7ht W ai YP nq e OM M A 9 1 Shot, ZfhLi I
Previous Business on this site W a
number of shifts, avail ble parkin spaces um er of
Describe the proposed business including use, number of emplR parkin
vehicles , and an additional information hat ou can provide: (( S(�,�[ (% C(/YV) V%RO,
c�Tuc �as�
*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'u1nderstand them, and that I will abide by them.
Signature N V �� Y C y � �: Y
Printed
APPROVAL INFORMATION
J''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
Zoning Official L 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
'1YY1
Intake to complete the following:
i
Y
Is bin LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Wil t
W =1 there be food preparation?
If so, give applicant a Health Department form.
_Zon ng_re iew can_ not_ begin_ until—w-e_receiv_e_approval_fcom -Heal_
Dept. FAX DATE
Circle the one that applies - -
Is parcel on private well or lic w er?
If private well, provide ea=t artment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on septic or ublic se . r?
Y/0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use:
� / N
Permitted as:
Under Section:
Parking formula:
Required spaces: U/
Y
Items to be verified in the field:
Inspector : Date:
Notes:
Viol tions:
Y /
Ifs , List:
Proffe s:
Y /
If s , ist:
Var' •n
Y
If so, List:
SP'
Y /�
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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