HomeMy WebLinkAboutCLE201000236 Review Comments Zoning Clearance 2010-11-18Applicati ®n f ®r Zoning Clearance
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CLE # 20/0 f 2-
OFFICE USE ONLY
❑ Zoning Clearance = $35
Check # 103 Date:
Receipt # D Staff: t7'TS
PLEASE REVIEW ALL 3 SHEETS
PARCEL INFORMATION-
1T 5� c-,' I — 3 Existing Zoning
Tax Map and Parcel:
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Parcel Owner: V i 41''
sr City V k, States
Parcel Address: i naY ��i� G!
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project9 y1
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Address: 50000 S f i wD `�l City w w [�esbora State V A Zip
Office Phone: 3L ` � Cell # Fax # E-mail, ®, frac'-'
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site Fl v
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 ermission to use the space indicated on this application. I also certify that the information provided
I the conditions of approval, and I understand them, and that I will abide by them.
is true and accura449 dg ve read
Signature � Printed
APPROV L INFORMATION
] Approv d as proposed [ ] Approved with conditions [ ]Denied
[ ] Bac0ow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
[ ] No physical site
site plan.
[ ] This site complies with the site plan as of this date.
Notes -
Building Official �— Date l ( a (
Zoning Official Date
Other Official Date
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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
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Intake to complete the following;
Reviewer to complete the following:
Y /a
Square footage of Use: J�6
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Li
SP's:
Y/N
If so, List:
ermitted as: P!2
Y /
o
Will ere be food preparation?
Under Section: �-1 �-•'
Clearances:^^ j
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:
Is parcel on private well or � ublic wat ?
If private well, provide Health epartment fonn.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y "I
Circle the one that ap. lies
Items to be verified in the field:
Is parcel on septic or 11 lic s
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / ��
Notes:
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7.,.,;,, lr 4n nnm lnl-n +ha fnllnwincr
Violations:
6�X N
If so, List: � � � f�
Proffer -s,;
Y
If so, List:
Variance:
Y /I�I
If so, List:
SP's:
Y/N
If so, List:
Clearances:^^ j
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3