HomeMy WebLinkAboutCLE201100089 Review Comments Zoning Clearance 2011-05-09Application for Zoning Clearance
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CLE # '2011
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY 5 r�11
Check # 03 Date:
A 2 103 Staff:
Receipt # 1�
PARCEL INFORMATION ����� M (� � � �� ,,0�
i)u i - 12 v Zoning I T °�
Tax Map and Parcel: I i 1 Existing
Parcel Owner: �
/ //� y�
Gr` #454(e State (�'f"1 Zip�O`�
Parcel Address:
(include suite or floor)
PRIMARY CONTACT
n 1 n ,
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Who should we call /write concerning this project?
�V!J/��r
C15 15C ri(Y"Gr Nar/C? 116 State VIA Zip."?
Address : City
Office Phone: 9,)',�'-100 Cell # 96Z -7W& Fax # ,2'd Y09 E -mail cJ eYfi
APPLICANT INFORMATION
Check any that apply: Change of Change of use/ -Change of name New business
jo�wnership
Business Name /Type: i 76� `�'�l it 4,,' Cht,,"nq — IY rlelle0SUl ,
Previous Business on this site V/
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:
*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 lmowl e. I have read the conditions of approval, and II understand them, and that I will abide by them.
y
Printed 1fG4�f� e6- 1'dn f " (7q'5
Signature
5
APPROVAL INFORMATION
[ ] 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 r� �3 ,G `ice Date
I
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
C:
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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 /�i
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 ' public w er?
If private well, provide He artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or lic- er?
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 #
Zoning to complete the followinLy:
Reviewer to complete the following:
Square footage of Use: 7 Z
)t /N
Permitted as:� I
Under Section: 2. Ja . 2'
Supplementary regulations section:
Parking formula: -1 D Gvl
U
Required spaces:
Y
IterhKo be verified in the field:
Inspector•
Notes:
Date:
Violations:
Y/M
If so" List:
Proffers:
Y /
If s , ist:
Varian e:
Y ItV
If so, List:
SP's.
Y/O
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
11
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