HomeMy WebLinkAboutCLE201100063 Review Comments Zoning Clearance 2011-03-23Application for Zoning Clearance
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OFFICE IMLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATI►(?PJ A,ti An i,► A^ n
Tax Map and Parcel: U tMUU -`A-) LAP (JTtr_ U Existing Zoning
Parcel Owner: JtJC�C�
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Parcel Address: City State Zip
(inclu le suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? .
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Address : 1 �/�j � � b��� Cit � i Vi 1, � State Zip
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Office Phone: L_) Cell # J34 -o -TiW 'x # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
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:
*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, 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
APPROVAL INFORMATIO
[,,],'Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backllow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 17.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
f .I This site complies with the site plan as of this date.
Notes:
- �
Building Official Date 3 r13 tl
_
Zoning Official Date
Other Official Date
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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 2of3
Intake to complete the following:
Y/0
Is use in LI, HI or PDIP zoning?
Engineer's Report (Cl--,R) packet.
If so, give applicant a Certified
Y
W ill sere be Food preparation?
If so, give applicant a 1= lealth Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well of u lic Ovate
If private well, provide I-Iealt i epartment form:
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic u lic._sew
Y/N
Will you be putting up a new sign of any kind?
Sign permit. 2
Permit #
I f so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obt ' e roper e mid
Permit # '(
ZoninEF to complete the following:
Reviewer to complete the following:
Square footage of Use:
f'ei m fitted as:
Under Section: %� X ✓� a ?,5 kR j 1 k
T.
Supplementary regulations section:
Parking formula:
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Requited spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol ons:
Y
If fist:
Pro ers:
Y
If so, ist:
Varia ce:
Y / N
If so, List:
SP'
Y /
If sot:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of•3
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