HomeMy WebLinkAboutCLE201000238 Review Comments Zoning Clearance 2010-11-18- -- - -- -- - -- X11\ '-I6� _�6 - - - -- - - - - -- --- - - - - --
Application for Zon* Clearance
CLE #
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— ' --------- - - - - -- --
Zoning Clearance = $35
- OFIICE- USE-ONL -y - - - - - - --
Check # Date:
PLEA REVIEW ALL 3 SHEETS
Receipt # Staff:
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_PARCEL - INFORMATION - — _ _ = -- - -- -- — - --
Tax Map and Parcel: Y57(-- 9,— 00100 Existing Zoning I^�
Parcel Owner: Mar-hfi
Parcel Address: City ICe- - State Zip 22 U%
(include suite or floor)
PRIMARY CONTACT LJ1,24
Wh o should we call /write concerning this pro' ject? r /
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Address: 7r () n/�/3�� W/�y /LI � City G�Gt�� . yl Late 1/� Zip d6
Office Phone: ( r' -0&Q Cell # -/ ZFax # E- mailel¢� i'I files f, sM61
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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: � 5 Fa� rl o.e ,5 , Jn G
Previous Business on this site 55 >°
Describe the proposed business including use, number of employees, numbed shifts, available parking spaces, number of
vehicles and any additional information that you can provide: -t S
42 �Zt 3 2 ` / �` c�Ges
*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 pennission to use the space indicated on this application. I also certify. that the information provided
is true and accurate to the best of my nowledge. I have read the conditions of approval, and I understand them, and that I abide by them.
will
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Signature Printed r a, !/11'I,ZV (
APPROVAL INFORMATION
Appro.ved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow 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 of this date.
Notes:
Building Official Date
Zoning Official Date Z/ I'54 l
Other Official Date
County of Albemarle Department of Uommuntty lieve►opmem:
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 follo`'s�ing: Reviewer to complete the following:
IN Square footage of Use: %� D U J
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
_ Engineer's Report (CER) packet. O / N
- -- — -- -- - - - - -- -- - — — - -- — errnitted -as: - )
Y/
Will there be food preparation? Under Section:1:
-1f 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 ap ' Parking formula:
Is parcel on private well or •?l / %JJ
If private well, provide H rtment form.
Zoning review can not begin until we receive approval fi•om Health Required spaces:/
Dept. FAX DATE 6
Y/
Circle the one that app ' Items o be verified in the field:
Is parcel on septic or a r?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign peimi�
Permit # Llspector : Date:
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #— r
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Notes:
yR'f' olations:
/N
so , List: } � R
ProMist:
Y
Ifs .
Vari e:
Y / )
Ifs , ist:
s:
If / so", -ei
If 1st:
Clearances:
SDP's
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Revised 04/28/08, 10/13/09 Page 3 of 3
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