HomeMy WebLinkAboutCLE201100047 Review Comments Zoning Clearance 2011-03-18♦' Ina NOV I y
y Application for � oni�ClearanceY`r
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O ll
Clieck # WZ Date: '
Receipt # — Staff: jDt
PARCEL INFORMATION : n
Tax Map and Parcel: _ [ A ' C'�' 1 `�96aiIi a /, /, _ ) j V li' Existing Zoning ��� V
Parcel Owner: `�' r -78 — / 7,J
Parcel Address: 2 tc &rnQn City t� State V!� Zip
(include suite or floor) 5M /O2
PRIMARY CONTACT
j�n(
Who should we call /write concerning this
p,,r�oject?
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Address : 32(.�. Ui 502 C /ity (i "(/(JU State VA Zip �!
Office Phone: Cell # 1-13q327 Fax # E -mail /%(,�%%�%(�tL:GK // k�•I�j�
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: y�hh 6L �, ,�a W ` P� of f RWV
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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: — Q
*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 V Printed dM l..JtQ%/
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 Flo
Zoning Official AA. Date 1 T' I l
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
Y/N
Circle the one that ap es Items to be verified in the field:
Is parcel on septic p bfic sewer?
Y/N
Will you be putting up a new sign of any ]rind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
i Permit #
G
:1,nnincr to rmmrilete the fnllnwin (Y-
Viol s:
Y �N�
If s�ist:
Intake to complete the following:
Reviewer to complete the
/following:
Y N
Square footage of Use:
SP'
Y
If s , List:
Is uI, HI or PDIP zoning? If so, give applicant a Certified
I.
Engineer's Report (CER) packet.
Y / N
1 Clearances:
SDP's
ermitted as:
Wi Nere be food P reparation?
Under Section:
If so, give - applicant -a Health Department form,
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Parking formula:
Circle the one that applies
;."e )for"'.
Is parcel on private well or ublic
If private well, provide Heal t
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that ap es Items to be verified in the field:
Is parcel on septic p bfic sewer?
Y/N
Will you be putting up a new sign of any ]rind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
i Permit #
G
:1,nnincr to rmmrilete the fnllnwin (Y-
Viol s:
Y �N�
If s�ist:
rrffers:
Y�1 N
f so, List:
Var' n
Y/ J
If soist:
SP'
Y
If s , List:
I.
u
1 Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
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