HomeMy WebLinkAboutCLE201100069 Review Comments Zoning Clearance 2011-04-06Application i ®r Zo ning Clearance
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CLE # '
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OFFICE U E NLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff: `
PARCEL INFORMATION pp
Existing Zoning H
H TaxMap and Parcel: - - 6
Parcel Owner: Vi R(Sr,1 h) /A LAN-D TR UST
Parcel Address: 9, S ! i CC - 02— City C[n "U 6 I l D State V Zip Z Z-9 It
(inclulle suite or floor)
PRIMARY CONTACT II ((��
�`Cy-c ME
Who should we call /write concerning this project? 5 L a Ol/!!:�
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Address: q l l A/1 ��1 City � (A f � State V k Zip
Office Phone: (Bj � 9- f kell # 9 S1 Fax # G(p 3516 E -mail V LC V 0404 e 6l +
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APPLICANT INFORNIATION
Check any that apply: Change of ownership %`Change of use Change of name New business
Business Name /Type: 11�C�cl /�05Tf fT I LS . /
Previous Business on this site l+ y t p (�L/ J i S
Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of
vehicles, and any additional inf rmation that yo can p ovide: ;a . J-11njQ ` 1 CLA t'- ' t ✓� AA
1 �l� �� I. C_ S 1` t 1 C-1 At C--7 j LAS 1 A-) �zS
*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., Printed VteA) M /U6 / IDA
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APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ J 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 `-1 q f (t
Zoning Official =Z d; Date
t/
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 toll—owing: Reviewer to complete the following:
Y/ N Square footage of Use: j 3% 0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. 9 / N � �
Y/N
Will there be food preparation_?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or public - water ?____
If private well, provide Health Department 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 public sewer?
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 # 51zol/
Zoning to complete the following:
Permitted as: S � ,vl A C)
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
If `r 1
If so, ist:
Proffers:
If
Y Pist:
Variance:
Y/ 1
If so, ist:
SP's:
Y/
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
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