HomeMy WebLinkAboutCLE201100079 Review Comments Zoning Clearance 2011-05-17Application for Zoning Clearance
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OFFICE USE ONLY I J(:? 'Ftv — - 7c Fi�hclva:r:�
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PLEASE REVIEW ALL 3 SHEETS
Check# Date: k,7,74,
Receipt # Staff:
PARCEL INFORMATION 6;0
Tax Map and Parcel: � ,s - 40 A(") Existing Zoning
Parcel Owner: �Ua_ }lea -( 16s4+c- IIFOLX-04�0y%
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Tiria Parcel Address: (�t�1/V$ �'v�I%�111y� City 1 /{ 'I State _ Zip
(include suite or floor)
PRIMARY CONTACT h
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Who should we call /write concerning this project? � Vp,1n._ r g .
Address l AV'1 551 � zo l City V, State Zip
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Office Phone: ( ) �� 7 Cell # Fax # `d �' e �► E it ��/ {�i1� ,J +ou . e
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: WOU-vnAl-t Wvorytor •g S k Zcc.v�z Lj 2Cy t
PDPietns Business on this site ViiV A me, A,, PCAV'k
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 cer ' 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 a,curat to a est my ledge. I h read the conditions orapproval, and I understand them, and that I will abide by them.
V -/L �
Signature Printed G}%jjl�
AVROVAL INFORMATION
J Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
I ] This site complies with the site plan as of this date,
Notes:
Building Official Date 331
Zoning Official _ I �t/; 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 1/1/201 1 Page 2 of 3
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Intake to complete the following: Reviewer to complete the following:
0 N Square footage of Use:
!s use in Ll, I-Il or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. �/ Y / N
Permitted as: AcusSov)? LA sr'
Y / N~
Will there be food preparation? Under Section: QQna�Q ✓fl��cy
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section: 0%4
Dept. FAX DATE
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 Nye receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Items to be verified in the field:
Circle the one that applies
Is parcel on septic or public sewer?
ti/A
N /ak
Y / N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y /a Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7.nnina to rmmnlete the fnllnwin;y-
Violations:
.Y /N
If so, List:
Proffers:
�� N
so, List:
Variance:
Y / N
If so, List:
SP's:
N
If so, List:
Clearances:
SDP's
y� �s
Revised 1/1/2011 Page 3 of 3
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