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HomeMy WebLinkAboutCLE201000227 Review Comments Zoning Clearance 2010-11-09f Application for Cloning Clearance '�6 m t, ��RGIN�P / [r Zoning Clearance = $35 OFFICE USE ONLY Check # ���% Date: PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: _PARCEL INFORMATION Tax Map and Parcel: ow yc) — 00 --'00— � d y Existing Zoning Parcel Owner: Parcel Address: City State Zip (include suite or floor) PRIMARY CONTACT V i�e�.�� l /VA--T-eA-, Z( , Who should we call /write concerning this project? i S �-�-r cy!� ` VA (�'� Address: f City State _ ZipZ "aOfce Phone: � °Z9 E "7� S Cell # `N -S3( �Fx # E -mail APPLICANT INFORMATION Check any that apply: Changp of ownership Change of use Change of name New business �'C" �f P/�V /3 Business Name/Type: / 1 " v`� I Previous Business on this site 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: *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 understand them, and that I will abide by them. Signature - �-J�_. Printed IL t y APPROVAL INFORMATION XApproved as proposed [ ] Approved with conditions A1,x enied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -45 T [ ] 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 it 19 O Zoning Official Date a&//) 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: Reviewer to complete the following: Y / © Square footage of Use: e-44Jv Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Permitted as: Will`tlfere be food preparation? Under Section: If so, give applicant a Health Department form. 7nnino review can tint begin until we receive approval from Health I Supplementary regulations section: Dept. FAX DATE Circle the one that applies Is parcel on private well ubT ater? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic of public ewer? Y /CN) Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / (I� Will ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Parking formula: pp �'u Required spaces: Y N Ite o be verified in the field: Inspector: Notes: Date: Gonmg w cuui itlt lilt lvllvYrlll 'olations: Y/N so, List: � I � � j [� Proff Y/ If so; ist: Var' nce: Y/ If so ist: �s' /N so, List: Clearances: �1 SDP's--- - Revised 04/28/08, 10/13/09 Page 3 of 3 i 4s cp -'" 660092-EVEP ,O:ZT t- ICI