HomeMy WebLinkAboutCLE201000216 Review Comments Zoning Clearance 2010-11-01pplicati ®n f ®r Zoning Clearance
7-11,9
Zoning Clearance = $35
PLEA PE REVIEW ALL 3 SHEETS
OFFICE USE ONLY C5 �' I�
Check # Date: !
Receipt # J)2_ Staff:
PARCEL INFORMATION
Tax Map and Parcel: -' Existing Zoning
Parcel Owner: _NLnn.Q'' ,1n oh �.n
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Parcel Address: 11I oy-_ 4 I'a--1 -yL city DuY161'1'c;(14J L State -M � Zip ZZgI/
(include suite or floor)
PRIMARY CONTACT 0 -�{
Who /write
should we call concerning this project?
Address INp -K/k Pb_y1L City State V14 ZipmL
OfficePhone:(ffb q(o4-DQW Cell #03- bg -HI57 Fax #Y3�_ E -mail r.0. d-(-0, CL
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: �-� < �'( / l �l/l1U Q Q'"_
Previous Business on this site IQUOA1,,i/JC1 'OfAW
Describe the proposed business including use, number of employees, number o shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: 4-5ev u,.6
, k_emote (x. � G -t- A,. G X. 9/y�
*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 acc ate to the est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
,
Signature v Printed I Y-C' Ln n �-�-
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, 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 Date al).hl)
Other Official Date
t.ounry or Aioemarie 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:
Is/
Is useii6 use ' LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /,
Will ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Circle the one that applies Parking formula:
Is parcel on private well or u;bfic water.
If private well, provide Healt partment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or ublic sewe ?
Y/0
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Y/N
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
Y /( N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y�
If so, List:
Prof s:
Y /
If so, List:
Varian e:
Y/V
If so, List:
SP's:
Y/6
If so, List:
Clearances:
SDP—'s
Revised 04/28/08, 10/13/09 Page 3 of 3
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