HomeMy WebLinkAboutCLE201100080 Review Comments Zoning Clearance 2011-05-04Application for Zonln Clearance
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CLE # ��-
OFFICE US PLY ,q ))
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMA T�) �j� !t� r�
Tax Map and Parcel; l T `� V0 -D t yU Existing Zoning�r Kai" ter +'IIJO !
Parcel Owner:
Parcel Address: CitYCW `� ..er State t1A Zip
(include suite or floor)
PRIMARY CONTACT
Who should ive call/write concerning this project? A"1 .
Address:.... Sgm 41. bl r i ( City ( State 7,1P 02P �U
Office Phone: C 5631 ) Cell # 0 Fax # E -mail
APPLICANT INFORMATION
Check any that apply; Change of ownership Change of use Change of name New business
Business Name/Type: V 6d�0er/ AMA- i C-.O— (t ace r
L be, �-
Previous Business on this site i try
Describe the proposed business including use, number of employees, number of shifts, availabie arking spaces, number of
* "�� Cb�acPitH
vehicles, a d any additional information that you can provide; l,�,i�t�5y S:D�Gi
*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 y Imo +viedge, have read the conditions of approval, and I understand them, and that I will abide by them.
Printed
Signature
APPROVAL INFORMATI
U] 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 ''• JQ Date �b�t { i
Zoning Official Date !;40- 1I
Other Official l�''� �% Date
f /fit. o u rs 141) ¢tr YA '
County f Albemarle - Department oJ/Lommullrry yeveropmenz
401 McIntire Road Charlottesville, VA22902 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:
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Is use in LI, HIorPDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet,
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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. FAQ. DATE
Reviewer to complete the following:
Square footage of Use:
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Permitted as:
Under Section:
Supplementary regulations section:
Circle the one that applies Parking formula:
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 Required spaces:
Dept. FAX DATE
YIN
Circle the one that applies Items to be verified iu the field:
Is parcel on septic or public sewer?
YIN
:Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Per:nit # Inspector; Date:
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
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Notes:
Violations:
YIN
If so, List:
Proffers:
YIN
If so, List:
Variance:
YIN
If_so, List:
SP's:
YIN
If so, List:
Clearances:
SDP's
Revised 1/112011 Page of
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