HomeMy WebLinkAboutCLE201000226 Review Comments Zoning Clearance 2010-11-08Count)' 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
Application for Bonin ;Clear°an:ce
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CLE #
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Zoning Clearance = S35
OFFICE USE 0
Check 4 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # —4 �_ Staff:
PARCEL INFORMATION
-- Existing Zonin
Tax Map and Pare
Parcel owner:
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Parcel A ddress;
. (include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? C GY
j �' State Zip 22 1
Address: �fl �fi. �� t Cit}
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Office Phone: (_) Cell # ax # E -mail (eq
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use _Change of name New business
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Business Name /Type: ' C
Previous Business on this site
Describe the proposed business including use, number of employees, number of lifts, available parking spaces, numb r of
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vehicles, and any additional information that you can provide: e� i a��
*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
best no ledge, have read the conditions of approval, and I understand them, and that will by them.
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is true and accurate t - e of m,
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Signature Printed r
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APPROVAL I ORMA N'
Approved as proposed [ ] Approved with conditions [ ]Denied
[ J Backfiow 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 detennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as ofthis date.
Notes:
/
Building Official Date I i
Zoning Official ✓ Date
Other- Official Date
Count)' 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: Reviewer to complete the 1,0110wing:
1' 1 Square footage of Use: n�
Is U&I, HI or PD1P zoning" if so, give applicant a Certified
EngiLoefood ' Rport (CER) packet. / l�
Permitted as: Y'?�� I`
Y /
Will preparation? _ _ Under Section; 2� Z r
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: T ��
T
Is parcel on private well otblic water•
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Ftems
Circle the one that applies
to be verified in the field:
Is parcel on septic or pu lic sewer?
Y /
Will be putting up a new sign of any kind? If so, obtain proper
Sign permit,
Inspector : Date:
Perm' #
Notes:
Y
Wil
'
e be any new construction or renovations?
If so, obtain the prroper Permit,
Permit #
honing to complete the follciWing:
Violations:
/7t
Proffe
Y/ r
f so, List:
If so, List:
All
Varia ce:
S,�'is:
l�.'/ /N
Y/
If so, List:
If so, List: M ��
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3
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