HomeMy WebLinkAboutCLE201100054 Review Comments Zoning Clearance 2011-03-17Application for Zoning Clearance
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OFFICE USE O LY
N� �eei Date:
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt # Staff:
PARCEL INFORMATION- ,.. Zo.ring-- - -� - -I ! -- - - --
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Parcel Owner: `�fla,?�Ci. - ��(l i�j fl - -SZ,I �il ) � � c.[.(� 1v /A/
Y 2290
Parcel Address: City State Zip
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PRIMARY CONTACT 'r C
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Who should we call /write concerning this project?
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Address.: � tM.lA1R5 '%�I`�G�- City �V � State Zip
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Office Phone: eII # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change Of ownership of use Change of name New, business
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Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available arkinQ spaces, number of
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vehicles, and any additional information that you can provide: ,. i t
*This Clearance will only be valid on the parcel for which it is approved. Ifyou 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 t e owt er's pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of `' owledge. I have read the conditions of approval, and I understand them, and that I will abide by them. .
Signature Printed $}1R�12A" bG�GFI�l�I'�SUI�I'li�seCyi
APPROVAL INFORM TION "'ifl
[ ] Approved as proposed] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x l 17.
[ ] 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
Otlier Official Date
County 01 Albemarle Vepartment 01 Uommunity ueve1opmen1 .
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 1/1/2011 Page 2 of3
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Intake to complete the following:
Reviewer to complete the following:
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Square footage of Use:
Is uOin LI, HI or I'DiP zoning? If so, give applicant a Certified
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Engineer's Report (CER) packet.
be6iry
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Permitted as:
Will there be flood preparation?
Under Section:
Zoning review can not begin until we receive approval fi-orn Health
Supplementary regulations section:
Dept, FAX DATE
Circle the one that applies
Parldrig formula:
is parcal on privatewell ci� ;pu;b1i,:c�QDter9
Zoning review can not begin until we receive approval From Health
Required spaces:
Dept, FAX DATE
Circle the one that applies
lt=6�e verified in the Field:
Is parcel on septic
Will you be Putting Lip a new sign of any kind? 'If so, obtain proper
Sign permit.
Inspectof Date:
Permit #
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W'I I I be any new construction or renovations?
If so, obtain the proper Permit.
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