HomeMy WebLinkAboutCLE201000237 Review Comments Zoning Clearance 2010-11-17Application for Zoning Clearance
CLE #A 16 - 23
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PARCEL INF OR MAI1r1 0N.
Tax -Map_and Parcel:
Parcel Owner:— \.,V 0 0 �
Parcel Address: S 0 ru i T F1JT-T_ P'L city State VA zip -22,94 )
_1 _CL'U;7_W
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? yo SEe 14 A51V -at pl-!-
10 1f14J /-f 07)&r
Address: 21 ff, i-I /V 4-16W 91, VD IV24 3 - City Aif tT -/',z ru State zip -2-ezo')
) -1�Z I I Cell # -[o3- S-- S-o I Wax # E-mail
Office Phone: (h3 A S
APPLICANT INFORMATION
"Un' r� M
Business Name/Type: 75- C, , is FR P R7Z IR
Previous Business on this site x kod _T_( a V< -3�:- (\J C_
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: 6 a S fj= -2 la7 t-, Ke C
*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.
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Signature Printed Y� 5 Fdo
-'Ark I NEI OR L
A.N.J.
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Appto.vOid �.as� proposed M'oye_
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[ ;.] aekflow preventtoti device, and/or -cun ent test data needed f& this ""t., ;Contact ,�ACSA 977-45,.I�1.'.'x1.1-7:
site "n hhas-36op ti' ot o ff cpn1p ap cew k
No pilys�cal .
This ] is site complies with the P qr1A$.'Q.
TA V
a
Id Official:.
ing
.Bu
Zoning' Of t
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L County of Albemarle Department or (;ommunity JLPeveiopment
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
-Antakejo -complete the following:--- - -Reviewer-to-complete1he following:
Y / ..... .... Square footage of Use:
Is use Vin LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. P/ N
Permitted as:
Y
L!N e'
re be food preparation? Under Section:
if So, give applicant an Health Department form.
Zoning review cannot begin until we receive approval from Health Supplementary regulations section:
Circle the one that applies Parking formula:
Is parcel on private well o ublic water?
ptrr
"i o
If private well, provide Health e form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept, FAX DATE
Circle the one that appleg_�
Is parcel ce, on septic or ublic sewer?
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will er e any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7aninor to comnlete the following:
Y-Y N
Items to be verified in the field:
vii-T4 -U40 VIRCIMIP,
ficx-: aMQfN-1-1"Yj Ctj)&
Inspector Date:
Notes:
iolations:
�Y / N
If so, List:
rro if,
V / �' :
If S02 ist:
is
30.7
Variance:
Y /;�,)
If so, List:
SP's:
/N
if so, List:
Clearances:
SDP's
'AAA
Revised 04/28/08, 10/13/09 Page 3 of 3
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