HomeMy WebLinkAboutCLE201100114 Review Comments Zoning Clearance 2011-06-10Application for Zoning Clearance
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OFFICE USE ONLY
PLEASE REVIEW ALL 3SHEETS
Check# Date:
Receipt # Staff: r
PARCEL INFORMATION A�� r&U(i
Tax Map Parcel: l� I � P '�z, KA
and Kk/ Existing Zoning
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Parcel Owner: U /'"C 9
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Parcel Address: /p215D �.l�l S( C��,{�,� kl , State Vol.– Zip
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(include suite or floor)
PRIMARY CONTACT -�
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Who should we call /write concerning this project?
Address : i 0/ City C yl 1% State M Zip �Z�� z
Office Phone: ( ) Celle" &T WPax # E -mail en 6,
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APPLICANT INFORMATION
Check any that.apply: Change of ownership of use Change of name New business
�Cpph��ange
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Business Name 62�4, Tb% Ch,1
/Type: (� 0 0 /its' -6
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parkin,g9 spaces, numbe,� of
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vehicles, and any additional information that you can provide: no dow 5f�cf�S cCt/ ct
' kThis 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 t e 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 ,?knoNy d e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed � t c 0-0 O l
APP VAL 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. „n
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Notes:
Building Official Date
Zoning Official A Date plil2jil
Other Official A
r\x I
SH Q` l 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: Reviewer to complete the following:
Y / N Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. 011nitted N
as:
Y/N WiII there be food preparation? Under Section: A'u �(J
If so, give applicant a Health Department for
Zoning review can not begin until we recei e approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies Parking formula: e
Is parcel on private well or public w er?
If private well, provide Health Depai ment form.
Zoning review can not begin until e receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies Items to be verified in the field: f
Is parcel on septic or public s wer?
Y/N
Will you be puttin/upa sign of any kind? If so, obtain proper
Sign permit.
Permit#
Y/N
Will there be any uction or renovati ons?
If so, obtain the pr it.
Permit #
Zonina to comDlete the follnwinn:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of3
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