HomeMy WebLinkAboutCLE201100032 Review Comments Zoning Clearance 2011-02-22Application for Zonin Clearance
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OFFICE U-SE ONLY
6M 1 5ci X15 0'2' 'It
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # I bl.cf Staff: r
PARCEL INFORMATION _ J J .t , , RD ,
Tax Map and Parcel: Existing Zoning_ti01GYtylet3 Gleve,100 (?A,�-
Parcel Owner: SQL60 Cxr L-10 ct�d UplUv1L LL(-
Parcel Address: )G50 Shk 164J.rn 151 v� ;SIG . City C kCLJ` AeS V -tI t P State V4 Zip 3)-,�1 1(
in I &- it o oor a
PRIMARY CONTACT L
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Who should we call /write concerning this prro"jeect? ed'�vniClyl IC��
Address: D907 Pe ioN a^, Ae� City State Val Zip )a9 I
Office Phone: Cell # 309 -3163 Fax # E -mail �gfem',O i . t.2 . J • Cow
APPLICANT INFORMATION
Check any that apply: Change ownership Change of use Change of name New business
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Business Name /Type: C'M`R�� V f-�\,,-, iGL ,,,)4L ef- 5e ce, LLB.
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking s aces, number of
vehicles, and any additional information that you can provide: AV.& 1CXC.- 'iCWS w�l� be (i�� X ye�co
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wi11 Loc c3W_ s ;,V\ 4 wig A-U_-� ie�eec . wo—, II k& -e_ vein,`cted aA6 wy,wy poTk,� S !!o 4-S.
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to ena v loc�` ation, anew 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 Je��►:cx.\/\ �e�A-,
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, 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 _lei f r f
Zoning Official 1AA 1411 A Date UZ if
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 1/1/2011 Page 2 of 3
Intake to complete the following:
Y
Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /� N J
Will ere 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 o CIth water?
If private well, provide He form.
Zoning re view can not begwe receive approval from Health
Dept. FAX DATE
Circle the one that ap 'es
Is parcel on septic or public sewer?
Y /
Will u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y N
Wit )ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
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�YT ermitted as: 016'6
Under Section: PA--Pb J -7 � 5 • g• 1 11
Supplementary regulations section:
Parking f r ula:
ore (Q : ltm
Required spaces:
Y/
Ite i to be verified in the field:
Inspector : Date:
Notes:
Vio ti ns:
Y/N
If so, ist:
Prof
Y IN
If so, ist:
Var' n
Y N
If s , ist:
SP' .
Y
If so, ist:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
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