HomeMy WebLinkAboutCLE201000243 Review Comments Zoning Clearance 2010-12-10Application for Zoning Clearance
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[ Zoning Clearance = $35
OFFICE USE O LY
Check # C 07g Date: j2f -7
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel Owner: l ace Vv_cA�a,,.,.
Parcel Address: �2�Garaz�t�kJi,�SF� tg7 City C6adoikv•11-z State tlA -Z2--701
—Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
l
Address : ��� C,��de�s �k,,ci • Ske t o� City State 1/4i- Zip -Z, �D1
Office Phone: (93V) 973--72,-TV Cell # (`I °k) ` g4' 1'i!A Fax #(143y) `I13 -01V� E- mail `Te wry. cJ�,� ✓14](�/���ysQt ✓tc�S.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Sr_Kd tCf45 sic
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: I�.�„,n� Ih.e.�p r_ nW l��JNr ,zr
*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.
11 0 ° ,
Signature "�•� - "r �,.�.,.a Printed &icH -&rL_
APPROVAL INFORMATION
KApproved 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 determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date ( �Zl'
Zoning Official Date ,Z" ///)
Other Official Date
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
Intake to complete the following:
Y/
Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / te Will be food preparation?
If so, give applicant a Health Department form.
Zoning review cannot begin until we receive approval from Heal
Dept. FAX DATE
Reviewer to complete the following:
Square footage of Use: %; -% �j
N
Permitted as:
Under Section: Z
Supplementary , regal ations, section:
Circle the one that applies . Parking formula:
Is parcel on private well or public wa
If private well, provide I.th -De rtment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/
Circle the one that applies Items to be verified in the field:
Is parcel on septic o� is sewer.
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y/
If so, ist:
Proffers:
Y/
Ifs , ist:
Variance:
Y /o1
If so, List:
SP's
Y/O
If so, List:
Clearances: )
Al V
SDP's
Ci�av �b"7
Revised 04/28/08, 10/13/09 Page 3 of 3
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