HomeMy WebLinkAboutCLE201100044 Review Comments Zoning Clearance 2011-02-28Application for Zoning Clearance
CLE# 2b` L-
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OFFICE USE O�j'I�1'
PLEASE REVIEW ALL 3 SHEETS
Clleck # `�S Date:
Receipt # l Staff: r(
PARCEL INFORMATION ,
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` y` Tax Map and- Parcel: , a _
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Parcel Owner: �� �• C:
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Address - �q `— Cite Cs�t\`Z� a �State��C� Zip
Parcel ��ar�C��19�
(include suite or floor)
PRIMARY CONTACT
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Who should Nve callhvrite concerning this project?
Address L3 � � /��n a ^mote ' ��� Citf \ , State tr, Zip�a�a c
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Of'f'ice Phone: .j .� CeII #L43tt— �� S:' 33Yvax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: \.I<
Previous Business on this site
Describe the proposed business .including use, number of employees, number of shifts, available arlcing spaces, number of
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vehicles, and any addi� io�'al ;uf'orma%1, Il that you Call pro i e:
"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 aFcul•ate to thct Uest o 111y 1 owl ge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature — ,y ✓w =`� • _. Printed �v— �-- .
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl l7.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This s e complies with the site plan as of h's date.
Notes: L 9 —
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Building Official Date
—�
A�
'//v ' Date
ZOIiIIlg Official
Other Official Date
County of Albemarle illepartment 01 t-ommtuuty _uevelupmeui
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 1/1/2011 Page 2 of 3
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7n n`r *n nmmAntn thn fnllnwintr•
V V olations:
/N
If so, List: � J / � / 1�
Intake to complete the following:
Reviewer to complete the following:
N
Square footage of Use:�CJ
Is use in LI, 1 -11 or PDIP zoning? If so, give applicant a Certified
Ene„in er's Report (CER) packet. C--C-5 Vu o���
�c�{��vr•w -iz G6: t�J (�
Y /P-> 5
Will there be food preparation?
Y N
Permitted as:,-- 4L 4; S--Jq C--
Under Section:�/�
SP's:
Y N
If so, List: l _ J
Ifso, give applicanta HealthDcpartmcnt form. -- -. --
zonin review call tot beg Attil we receive approval from Health
Supplementary regulations section:
Clearances:
SDP's
Circle the one that applies _r `
Is parcel on private,well public Fvater7
Parking formula:
If private well, provide 1-le� Ifil'r �- Dei55i-finent form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Is parcel on septic or ublic sewed?
Items to be verified in the field:
Y/N
Will YOU be Putting Up a new sign of any kind? If so, obtain proper
i
Sign permit. i ALL
Permit # /It) ° /b
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #')00 7
7n n`r *n nmmAntn thn fnllnwintr•
V V olations:
/N
If so, List: � J / � / 1�
Proffers:
D/N
If so, List:
Val•i, nee:
Y /(1 i
If so, List:
SP's:
Y N
If so, List: l _ J
Clearances:
SDP's
Revised 1/1/2011 Page of