HomeMy WebLinkAboutCLE201100074 Review Comments Zoning Clearance 2011-05-23Application for Zoning Clearance
CLE #
PLEASE REVIEW ALL 3 SHEETS
OFFICE T '1r-,
Check # Date: Z�
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Receipt # E5 2JL06 Staff:
PARCEL INFORMATION %y
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Tax Map and Parcel: 06 1 U 0030 _ 0 Existing Zoning 1. v
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Parcel Owner: % t
Parcel Address: `�d�® 'd1��`" �jl � City c 4''-1q&-kr►d 1tate V* Zips 0
(include suite or floor)
PRIMARY CONTACT
Who should we concerning this project?
Address City State Zip
Office Phone: `` 3 1J1 —6' &) -Cell # 7 't" cWf J1 Fax # � Y� ��� a l 5 E -mail �� i^r�"V ,�V%AJ 4 r*40_r;�'
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
n
Business Name /Type:
Previous Business on this site �'(ji '(/i -r.�l �-�'(, �jg Ile(
Describe the proposed business including use, number of employees, umber, of shifts available parking sp ces, number of
information that W, � C4'� I �
vehicles, and any additional you can provide: e i�.'
*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 th t owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 0 "j d /p'/ /zhe�Le_ i
APPROVAL INFORMATION
[,o] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] 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
Zoning Official Date
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
Intake to complete the following:
Y /N�
Is use m LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /l fh
Wil ere 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 ablic water
If private well, provide HeaftWVeartrnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic o ublic sewer?
Y
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 Perms . _
Permit # °�b [ ( ( d
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 1 616
Y / N fI'',,,,,�I1,Ae rI� I&b Permitted as: ++�t11GtA1;�, 1 Q ltl
Under Section: l . a . c 43)
Supplementary regulations section:
Parking formula: fig /b
Required spaces: („
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Viol s:
Y /I
If so, List:
MMN
Y(/ N
If , ist:
Var e:0,
Y /�
If so, List:
's:
/ N
o, List: S?
Clearances:
SDP's
1IN-63
e�"y, Revised 1/1/2011 Page 3 of 3
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