HomeMy WebLinkAboutCLE201000228 Review Comments Zoning Clearance 2010-11-09I
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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
cation for zn ng Clearance
*
CLE # On - r
OFFICE SE ON
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❑ Zoning Clearance = $35
Check # Date:
Receipt # Staff:
PLEASE RENIIEW ALL 3 SHEETS
PARCEL INFORMATIQ
PD
Tax Map and Parcel: NO I oO OWO Existing Zonina
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Parcel Owner :� "' IJC.LJVr� � 7'�i�
t Q'I State `r Zipa
Parcel Address; t (Gz� cit.),
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? ZL121 t -r
Address: 121 lilac IZiGQq� �ri ✓� AF D Cit), C+ s r State Zip ?
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Office Phone; (_� - S '" z Cell #7d -So3- 26 Fax # SAS _ 2
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Ty Plan
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 :P kt�r5i)n GSS 2 P� i�[v2�ee.3
*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
the of approval, and I understand them, and that I will abide by them.
is true and accurate to the best of my knowledge, I have read conditions
Signature " C Printed 'Zhaowei VJu
APP AL INFORMATION'
[ pproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or cut-rent 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
tm
Zoning Official � Date
�
Other Official Date
Intake to complete the following:
Y/N
is use in L1, Hl or PD1P zoning? if so, give applicant a Certified
Engineer's Report (CER) packet: - — -
Reviewer to complete the following:
Square footage of Use: �` '1 q
Will there 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
Circle the one that applies _
Is parcel on private well
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 appli
Is parcel on septic oL-12- is ewer]
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit,
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Pennit.
Permit #
ermttte as.
Under Section;
Supplementary regulations section:
i
Parking formula:
Required spaces:
Items to be verified in the field;
Inspector : Date:
Notes:
Zoning to complete the followinu:
Viol 'ons:
Y/N
If so List:
Proff.
Y/N
If so, tst:
Variance:
Y /
If so, is t:
SF's:
Y / N
If so, List:
Clearances: /
SDP's
... ... _._.::---.__.._._......._.,...._....__......_..__,: .... _ ...... . .._..__.._.__..___.._........__ _......__._._.- -- - --
Revised 04/28/08, 10/13/09 Page 3 of 3
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