HomeMy WebLinkAboutCLE201000215 Review Comments Zoning Clearance 2010-10-21rti,•
Application for Zoning Clearance
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CLE # O 1
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Zoning Clearance = $35
OFFICIO. USE ONLY
Check # , j 7 Date: .._
t SHEETS
PLEAS. � REVIEW ALL 3 ,SHOTS
Recei t # staff: 4
p
-P i2=CEL- INF0RMA;TFG Existing ZumZoning
Tax Map and Parcel. t / ` -
Parcel Owner:
y �� �: i9tG{' U. City (i 6'[offeSJt�IP State Zip?`
Parcel Address: v F�^�
(include suite or floor)
PIUNLkRY CONTACT
Yl O c
Who should we callhvrite concerning this project':
Address: �0 I LrAyr -�� G`P� city ..Ch State_ Zip ���0�.
Office Pltone: (� 7 Ili—WO Cell # Fax # E -mail l4TL, bric1G 1c.]'too, cote
AP U IINFORMATYON
-PLICA
Check any that apply: Change of ownership Change of use Change of name New business
Per Trick-
Business Name/'t'ype:
So na
Previous Business on this site
Describe the proposed Intsiness including use, number of employees, 11 unlb er ofi Sill f'ts, ailablc )ai-ltilig spaces, number of
51'itia
vehic es, anti any additional information that you call provide: �4�✓L�e� �d`�tk \ cy ru
--This Clearance will only be valid on the parcel Cor which it is approved. If you change, intensity ortnove the use to a new location, a new Zoning
Clearance will be required.
T hereby certify that [ own or have the owner's permission to use the space indicated on this application. T also certify that the information provided
is true and accurate to the best of my knowledge. t have read the conditions of approval, and f understand thcm,�td that [ will abide by dicni.
Printed n �rC in/ CAQ CA .
APPROVAL INFORMATION
J, [Approved as proposed [ ] Approval with conditions [ ],Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -451 1, xi 19.
] No physical site inspection has been done for this clearance. Therefore, it is trot a determination of compl ianec with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date
/
Zoning Official ` Date��Z� /���
Other Official Date
S- Uutlty Ut .............J
401 McIntire Road Charlottesville,VA22902 Voice. (434) 290-5832 Fax: (434) 972 -4 126
Revised 04/23,108 Page 2 of
Intake to complete the following:
Y;
is use n L1,1-11. or PD1P zoning? if so, give applicant a Certified
I:noineer's Report (CER) packet.
Y/\
Wi11 sere be food preparation?
if so, give applicant a Health Department form.
Guiinn review can jmr ?imnncil e i eccivc��ippro'val= from- 1 -leal
Dept. FAX DATE
Reviewer to complete the following:
Square footage of Use: / (]
a/N n(� ,
Permitted as: ;LP/L-e /� ' <✓ � � i' u�
Under Section:
Circle the one that applies
Parking formula:
is parcel on private well o puZic a�,-t
1f private well, provide Heatt i form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATES .r_.�.._..
Variance:
Y i
If so, 1st:
�
Y 1 r
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
-
Y I,NQ
Will you be putting up a new sign of any kind? If so, obtain proper
Sl)I "s
Sign pennit.
Inspector: Date:
Permit .
Notes:
Qti
Willre be any new construction or renovations?
11'so, obtain the proper Permit.
Permit #
1111111 ' CV
Violations:
1 .
If so, Gist:
1'ra rs:
Y / AH
If so, List:
Variance:
Y i
If so, 1st:
�
SP s:
Y / N
if so. .List:
Clearances,
Sl)I "s
Revised 04/28/08 Page 3 of 3
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