HomeMy WebLinkAboutCLE201100045 Review Comments Zoning Clearance 2011-04-08t ` I
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Application for ZoninF Clearances
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OFFICE USE O Y
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PLEASE REVIEW ALL 3 SHEETS
Check # r% Date:
Receipt # Staff:
PARCEL INFORMATION �A C
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Tax Map and Parcel: b(003 Existing Zoning v�
b(610/wo LAC
Parcel Owner:
Parcel Address: City C11211qC--1j, -- State JA ZipZ
(include suite or floor)
PRIMARY CONTACT
bF0zC9s tjm W--2�
Who should we call /write concerning this project? /--, ;j -6
Address: 15-7c) Q l- -Sy* � City !V' C-� State V� Zip2�9�
Office Phone: C46)4%- � F 7,h Cell # �d� '; Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 'i- D i= t.1 04? N,rt- I- 2,=& - W/ F
Previous Business on this site Mp o 5, bA+ y
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: /VA
*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 tha or have the o er's ission to use the space indicated on this application. I also certify that the information provided
is true and acc e t t of my edge have read the conditions of approval, and I understand them, and that I will abide by them.
Printed'?!�Rj/ rte
Signature
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 ( t
VA L41. 0 1 i
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 1/1/2011 Page 2 of 3
Intake to complete the following:
Y /
Is use n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 or pu lic.water�
If private well, provide Health De ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap ies
Is parcel on septic or ublic sewe .
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Wil N
dill there be any new construction or renovations?
If r obtain t per Permit. cgva ,,, n�
Permit # �t.J U 11'��'
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: �/ 11
d) �errnl
1
Under Section: (/1 VY ' g . ,
Supplementary regulations section: —�
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Parking formula: i,k ., � 11,60
Required spaces:
Y/N
It a verified in the field:
Inspector:
Date:
Notes:
PL uJk Elf aalkkAns
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Vio ions:
Y
If so, ist:
ffers:
,T? N
%SO, List:
Vana ce:
Y / N
If sc,� :
SR's•
Y /
If so,Qist:
Clearances:
SDP's � �m 3 il�L d np�i
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Revised 1/1/2011 Page 3 of 3