HomeMy WebLinkAboutCLE201100066 Review Comments Zoning Clearance 2011-03-30C t&
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Application _fir Zoning - leaxance
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Receipt # Staff: Uz
PARC.'+ L INFORMATXON y� } //q� y //%)'
/l /�' �' � 6 -O L �// isting Zvning�.
Tax Map and Parcels {/
Parcel Owner: Y I t
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(include suite or floor)
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Who should�L�'wee�call /write concerning this project? !a�
Application _fir Zoning - leaxance
CLE #
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ON I L
Check # Date: '� 1
Receipt # Staff: Uz
PARC.'+ L INFORMATXON y� } //q� y //%)'
/l /�' �' � 6 -O L �// isting Zvning�.
Tax Map and Parcels {/
Parcel Owner: Y I t
Parcel Address: �.J V�-t t� c 3Ul _ l �(l(i�� City t1� �C}C���State t%l Zip
(include suite or floor)
PRM4RY CONTACT j� �_
Who should�L�'wee�call /write concerning this project? !a�
J j
Address: ��p( ��'YlYr01'1E'U�L�t'n (, City 0Jk64r C 1 k,9_y6State z krk Zip L
Office Phone: Cell # ��Fax # 1 malt s4ao l n
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APPLICANT E\T, OLOWTION
Check any that apply: Change of ownership Change of use Change of name - New business
Business NamePSjpe: t � 1' �-e_ 110A JU_
Previous Business on this site C� l* r �+
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information flint 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, 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 Fnty kn tv]edge. I stave read the conditions of approval, and I understand them,, and that I will abide-by them.
Signature - Printed &Qaln U,aak,
APPROVAL INF RMATION
,&,] Approved as proposed • [ ] Approved with conditions [ ] Denied
[ ] Baokflow prevention device and /or current test data needed for this site, Contact ACSA, 977 -4515, xI I7, -
[ ] 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
Zoning Official Date
Other Official Da e
1
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CouWW'Albyfnarle Department of c:ontm try >eoevempmenz
401 "'McIntire Roa . Charlottesville, YA 22902 Voice:.(.43 ) 296 -5832 Fax: (434) 972 -4126
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Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use:
Is use in LI, HI or PD1P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
0/ N
Permitted as:
/N
Vari ce:
Y/O
If so, List:
Will there be food preparation?
Under Section:
If so, give applicant a Health Department form.
Zoning review cannot begin until we receive approval from Health
Dept. FAX DATE Zip
Supplementary regulations section:
Circle the one t ies
Parking formula:
Is parcel o rE2 ell or public water?
SDP's
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the opplies
Items to be verified in the field:
Is parcel o eptic r public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / N
Will there be any new construction or renovations?
Notes:
�`��5 "I Ilo d!✓ y
If so, obtain the proper Permit.
Permit #
7.nnina to emmnlete the fnllnwinae
Violations:
Y/N
If so, List:
Proffers:
Y 1
If so',-List:
Vari ce:
Y/O
If so, List:
SP's.
Y/
If so, ist:
Clearances - -- _
SDP's
Revised 1/1/2011 Page 3 of 3
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