HomeMy WebLinkAboutCLE201100049 Review Comments Zoning Clearance 2011-03-30r-
Application for Zo �n Clearance
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CLE #
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE&NPY �
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Check# Date: g, fl,
Receipt # Staff: 1
PARCEL INFORMATION _ I o
Tax Map Parcel: Existing Zoning_
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Parcel Owner: &4 �� ft ��Y n b j ( 5
Parcel Address: ee i ni City WXA State Zip L?`a)
(include suite or floor)
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PRIMARY CONTACT
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Who should we call/write concerning this project?
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Address: Uk-t loo S�T1 City �' d I4tate VA- Zip ®�
Office Phone: 191i #O l�J� Fax #
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APPLICANT INFORMATION
Check any that apply: of ownership' Change of use Change of name New business
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Business Name /Type: �I.i��•GVV 11 - C'hay W' , am 1
Previous Business on this site
Describe the proposed business including use, number of employ, es, num r of shifts, available parking spaces, number of
vehicles, and any additional informatio that you can provide: ��Ql�ee- �5 'nD ({'Y1� 1�ieS, � Lx,'t.Y � A-R
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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.
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
them, and thatpI will abide by them.
is true and accurate to the best of my knowledge. I have read the conditions of approval, ands I
uunderstand
�'�a����v�l Printed EI, � •kl.K -6
Signature �V� V W' -
APPROVAL INFORMATION
[ ]Approved as proposed [ ] Approved with conditions [ ] Denied
{f] 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 14 (1
Zoning Official Date r�
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
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Intake to complete the following: Reviewer to complete the following:
Y / Square footage of Use: y
Is usbn LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. O l N p L/ (�
� Permitted as: / Nr,C o � r1- rf 7 �1 �e�� � � 1' 4 c_ % I 1
Y /(N/
Will ere be food preparation? Under Section: i
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
Circle the one that applies
Is parcel on private well p?
If private well, provide Hea form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or ublic se
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Parking formula: A
Required spaces:
2�
Y/
Items to be verified in the field:
Inspector•
Notes:
Date:
Violations:
Y /
If s ist:
ProMrk-
Y/
Ifs ; ist:
Variance:
If /I1j
If so, ist:
SP's:
If /
If so, ist:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
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