HomeMy WebLinkAboutCLE201100036 Review Comments Zoning Clearance 2011-03-18C�
Application for Zoning Clearance
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OFFICE USE f
PLEASE REVIEW ALL 3 SHEETS
Ch eck # Date:
Receipt # Staff: J PI/ L(
PARCEL INFORMATION // r
& �! "�o -190 "`� o INFORMATION
Tax Mali and Parcel: - - Y) -- Existing Zoning "' !�►1 - - - - - -
40 '
Parcel Owner: D cm d e- L LQ, �
Parcel Address: rC� ,V�h i�' �A City 4 ls'p 1' zcmr tt, (o State V_A Zip A01
(include suite or floor)
PRIMARY CONTACT J/
�f? /�' )'lam
Who should we call /write concerning this project? i% 0 Q(l Q
Address RI V e)2.510\^ NV'e "Vi-k City V'� V 4tZ_.p4\eU W- PState ` ,a Zip G/t✓ o
Office Phone: (`�'3'� � W�� 1 1 Cell # SAI -ISZ- Fax # E -mail
APPLICANT INFORMATION INFORMATION
Check any that apply: Change of ownership Change of use Changeofnaame _New business
beh*�s
Business Name /Type: � ; - e..Y(-
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and an(y additional information that you can provide: - I c-,r, _ Pg (-19— pc, .
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*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.
Thereby 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 accw-ate to the best of knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Amy
Signature i n, ". Y Vtf MGR__ _ Printed tt ( -C) y t q of
APPROVAL INFORMATION
[ VApproved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[kj,)<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 th's at . ,
Notes Z
Building Official Date _�L_l ('-z h
Zoning Official Date l 6 1
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:
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil sere 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 r public water?
If private well, provide He liven of m,
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap es
GIs parcel on septic r public sewer?
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sigii.permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to emmnle.te. the. fnllnwinu:
Reviewer to complete the following: /��
Square footage of Use:
DY N
,-P-wrnitted as:
Under Section: ` !
Supplementary regulations section: - --
Parking formula:
Required spaces:
Y/N
Itei be verified in the field:
Inspector : Date:
Notes:
Vio tons:
Y V N1
I „f.so, ist:
Pro
Y /N
If p� 'st:
Vai i, ev
'Y /�
If s , st:
SP's:
Y/N
If so, List:
Clearances:
SDP's
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Revised 1/1/2011 Page 3 of 3
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