HomeMy WebLinkAboutCLE201000248 Review Comments Zoning Clearance 2010-12-28Application for Zoning. Clearance
CLE # 2L in
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Zoning Clearance = $35
OFFICE USE ONLY 0. 1 6
Check # ' Date: '/ I
? �S
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
T A" ET TI�TTl1T)T✓T A TIF
FR CIA, 11ff, 0, 11V
Tax Map and Parcel: ®(H U O -04-00 - 00300 Existing Zoning_ 1 9
Parcel Owner: PoL C % L L .-
Parcel Address: 7-146 -9crV-_ ► `A-r Dr- City CV,1Lrlo�VAke_ State v A Zip 22401
(include suite or floor)
PRIMARY CONTACT
plc.
Who should we call /write concerning this project? IJ5j0es„T ta�.f
Address : City State Zip
Office Phone: L Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
/ n/
Previous Business on this site r Ov e,
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 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.
Signature / 1 �✓�,..E,.�[%, 'ems. Printed
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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
Zoning Official 1/115_ Date 2—�' / /�i
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 Page 2 of 3
Intake to complete the following:
Y /N�
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engin er's Report (CER) packet.
Y / 1
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies .._
Is parcel on private well � puhli�vater?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap It
Is parcel on septic or c � er?
Y /(IVY
Will \yrAu be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y10
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoniIIL to comDlete the followine:
Reviewer to complete the following:
Square footage of Use: //D9
errmitted as: , ti Si N 5 cr V 1 Le
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: f%
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/(I�
If so,`�,ist:
Proffers:
Y/
If so, -fist:
Vari ce:
Y/ ;)
If so, List:
SP's.
YD
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3
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