HomeMy WebLinkAboutCLE201000249 Review Comments Zoning Clearance 2010-12-2112/21/2010 20:28 9724310
6
#4551 P.002/004
Application for Zolnin-F Clearance
CLE# z
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EZoning Clearance =$35 --
PLEASE RE'VSl(aW ALL
Check# mt J Dace: ` /!4y' /(J
Recalpt # Staff: �
3 SHEETS
`?2MCEl INS'ORMA TIOM�0 —'
C�- - -,�--
/ Nip
Tax Map an
Map d parcel: _ Existing Zonin
Parcel Owner: C 014 (� 6�4 L2 195
r
Parcel Address; Ity / QP_ —State ZIi
q.,14 —, u (include sulfa or floor)
(.A.)(t'.Y'
PR�M CONTACT r
wo
Who should call /wrlto concerning thls project?
Address : �P 1� City State Zl M
Office Phona: - ell # 1Rax tf 2 E-mail
APPLICANT INI'ORMA.T ION
Check any that apply, Change of o"nershl Change of use _Change of name New buslttess
Business•NxmelType:
pp
Previous, Business on this site
Desc'rlbe the proposed buslness Including use, camber of employees, n tuber of tNtlfts, avoUable parki spaces, number of
vehicles, and airy additional htformatlon that ou can provlde: M21)(.
*This Clearance will only be valid oil the parcel lbr which it is approved. If you change, intonsi.fy or move the trap to a new location, a new,Zoning
Clearance will be required.
I horaby corn* that t own or bavo the owner's parntission to use the spaceindicated on this applioadon. I alao carofy that tltcinfovnatioa provided
Js true and accurate to die bast of nay knowledge.1 havo road die conditions of approval, and I understand them, and char l will abide by thorn.
Sigliature �;6k!IdJ l/1 Printed 62, ` /6 10
APPROVAL INFORMATION
Approved as proposed ( Approved with conditions [ ] Donied
( ] Bacld7ow prevention device and /or current test data needed for this site, ContactACSA, 977 -4511, x117.
(. ] No physical situ inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
slto plan.
(" ) This site complies with tine site plan as of this date.
Notes -
Duilding OfiiciM Date -xz I'm
ZoniugOMICIAI Date;
Other Official Date aT lu
county or Awetnarte iiepartmem o► t-ornmuutcy ueveropurnar
401 McIntire Road Clrnrlottesvllle, VA 27902 Voice: (434) 296 -5932 Fax: (434) 9724126
Revised 04/28/08, 10/l3/09 Page 2 of 3
Intake to complete the following: Reviewer to complete the following:
Y / N Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified �. )
Engineer's Report (CER) packet. Ll J N
mitted.as:_.._
nY /N
ill there be food preparation? Under Section:
_if so, give applicant a Health Department form.
- Zoning-review- cannot begin until -we- receive approval from Health - -Supplementary - regulations section: -- —
Dept. FAX DATE
Circle the one that applies
Parking tormula:
Is parcel on private well or lic wa .
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Variance:
Y /(l�
If so, ist:
Y/N
Circle the one that applie
Items to be verified in the field:
Is parcel on septic or blic sew ?
Y
Wil you be putting up a new sign of any kind? If so, obtain proper
-
Sign permit.
Inspector : Date:
Permit #
Y /(9
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Viola ions: v
If/,i
If so, ist:
Proffers:
Y/
If soq , ist:
Variance:
Y /(l�
If so, ist:
SP's:
Y/1
If so 'st:
L
Clearances: �n V
SDP's
i.
Revised 04/28/08, 10/13/09 Page 3 of 3
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