HomeMy WebLinkAboutCLE201000244 Review Comments Zoning Clearance 2010-12-09Applicati ®n I Yoazo-o Wig Clearance C L E #
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❑ Zoning Clearance = $35
OFFICE- E-ONLY---- - - - - -- - - -- !,
Check # Date: V
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
= PARCEL INFORMATION --
Tax Map and Parcel: 0 13 A a Existing Zoning
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Parcel Owner:
Parcel Address: City State Zip
(include suite or floor)
PRIMARY CONTACT
CCtU�q �"' C'A JW�
Who should we call /write concerning this project? 1
Address : 1403 City i1nm %17 .State ya Zipx7 d
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Office Pluone: (0 �U �I Cell # � 1 0th o Fax # E- ma11S�1�6CCx� Gr� 0?J • a
APPLICANT INFORMATION
Check an), that apply: Change of ownership Change of use Change of name New business
Business Name /Type: (10ylfjYtl;.Ct 11-IN1 s-
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 infomlation 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 ) - 1" YU"
AAP ROVA L INFORMATION
as [ ] Approved with conditions [ ] Denied
pproved proposed
[ ] Bacl<flow 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 determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date (�! i� (Q
Zoning Official Date
Other Official Date
County of Albemarle Department of Lommumty uevetopment
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 / N Square footage of Use:
Is us ' i LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. Y / N
- -
Permitted as: Y /)
- - . - - - - - -- - - - -- -
will ,sere be food preparation? Under Section: -7 . z
- 1f -so- give - applicant a- Healtli-Depadment_fovn, _ _ _ _ _ - - - -- -- - - - --
- - -- Zonina- review - can - not begin until -we receive approval from -Hea]th Supplementary- regulations section: --
Dept. FAX DATE
Circle the one that applies
Is parcel on private well
Parking tormuia:
If private well, provide Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Required spaces:
Dept. FAX DATE
Y/
Circle the one that ap 1'
Item e verified in the field:
Is parcel on septic of ublic sew -
P's:
Y/N
If so, List:
Y /N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
Inspector : Date:
Y N) Notes:
Will sere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZJVII UA 6V %.Vlll •l.w Vuv lv aav r
Violations:
( /N
-'i'f so, List:
Proffers:
Y/
If so, List:
Variai e:
Y/
If so, List:
P's:
Y/N
If so, List:
Clearances:
SDP's
Revised 04/28/08, 10/13/09 Page 3 of 3