HomeMy WebLinkAboutCLE201100009 Review Comments Zoning Clearance 2011-01-20Application for Zoning Clearance
CLE# aD�j
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION n /1
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Tax Map and _Parcel_Ua.I T-E � - a°yki ExistingZonin _ - -1
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Parcel Owner:
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Parcel Address: City 1 , State V� , zip
(i hide su t or f)or)
PRIMARY CONTACT
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Who should we call /write concerning this project? u' --e-
Address: City State Zip
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Office Phone: (q5q) '1I 3 -- 7( (,q f;ell # 4 3q, l 9"1 'F Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use of name Ne`v business
_Change
Business Name /Type:[l�tt
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 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 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, xi 17.
[ ] 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 Date
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 1/1/201 1 Page 2 of3
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Zoning to complete the following:
Violations:
Y/N
If so, List:
Intake to complete the following:
Reviewer to complete the following:
Y Q
Square footage of Use:
Is use in Ll, HI or PDIP zoning? If so, give applicant a Certified
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Engineer's Report (Cl--,R) packet.
Y / N
Permitted as:
Clearances:
Y /
Wil! ere be food preparation?
Under Section:
=1fso, give - applicanLa licaltl7- Department -form.
__-
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well o ublic water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Items to be verified in the field:
Circle the one that ap iel�
Is parcel on septic or II 5 w C -•-
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign perm' .�
Permit # uld
Inspector : Date:
,(
f v) / N ' \���
Notes:
Will there be any new construction or renovations?
If so, obta t e,proper P1111 it.
Permit #
Zoning to complete the following:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 1/1/201 1 Page 3 of 3