HomeMy WebLinkAboutCLE201100078 Review Comments Zoning Clearance 2011-04-27Application for Zoning Clearance
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CLE # 2,611 qS
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OFFICE USE Y
Check# 2 Date: _Zf7 I
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff: YYVj° J
PARCEL INFORMATION +� f
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Tax Map and Parcel: Existing Zoning
Parcel Owner: Lo gc'n M Or+i n
Parcel Address: late � Zip 22901
(include suite or floor)
PRIMARY CONTACT
�ooYd @�90 S1.lYti' V� F���
Who should we call /write concerning this project?.if�i.
Address: 100S Ser\Ai h6k T. City CW Id1f� I le State V Zip 22qp 1
Office Phone: ��'. -Cell Fax E -mail _ I�' rj d@ clQ�s1,(,��°-p-( rV c,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: C i y surf, -r*c, � s^cwt°m end' CO 1 LL- .,
Previous Business on this site l,m"WVL
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide FTi,At jmU (Lae- 15 �e _ U+Uff U i 3Ct)'1RkWa j
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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
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 vo—v Ic- 4' Floyd (ma w
GlOS1,txGT1 C ¢ {VY►CV�� CDC
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backhow 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 (' i
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
)• LAC.
Orl'?
Y'
Intake to complete the following:
Y
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will t 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 public wate 7
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 ublic se ?
'Y )/ N
dill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /n
Will t sere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to cmmnlete the following:
Reviewer to complete the following:
S quare footage of Use: A60
01 N n �?
Permitted as: Yot Y O-W (.e....
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
wlations:
Y/N
``` so, List: jj
Proffers:
Y/
Ifso'–,fist:
Varian e:
Y /
If so" List:
SP'
lN Y '
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3