HomeMy WebLinkAboutCLE201100129 Review Comments Zoning Clearance 2011-07-18Application for Zoning Clearance
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OFFICE USA R�,T�'
��7:J Dates � l� L A
PLEASE' REVIEW ALL 3 SHEETS
Check.#
Receipt # Staff:1
PARCEL INFORMATION n r ` �QClf(VP/I rn�d'i
Tax Map and Parcel: q8 - i `-H Existing Zoning
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A/ 6� 616 5C Gyywfm
Parcel Owner: h � O � V�
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Parcel Address: (25 � VC�1 bffl I bar, City l,U c��I, o) State V A Zip
(include suite or floor), I e z
PRIMARY CONTACT
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Who should we call /write concerning this project?
Address : d�12� (� l hlrns City 1C�U OCSV tate Y Zip
Office Phone: LL L) Cell 45yj�'f-L X# E -mail -&-A e . YL .Uf CO'M66
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name business
__New
Business Name /Type: 9 0 itoc Aa cP_I�r A l�l('aC7 p , LI.C. tn�h l t'tDll
Previous Business on this site IYl 4
Describe the proposed business including us , number of employees number o shifts, available parking spaces, number of
/o
vehicles, and any additional information that ca provi e:
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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 inforn-iation provided
is true and accurate the best of my knvwleda . F have real time cmmtlitio'ns. of approval, and- II understand them-,- and that I. will abide-by therms:
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Signature Printed I 1 STS ► Y��
APPROVAL INFORMATION
(,, `Approved as proposed [ Approved with conditions [ Denied
[ ] Backt1ow 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 Z 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
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Intake to complete the following,
Y /
Is us m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y "N
/ )
Will 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 r public w er?
If private well,•. provide He artrnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
I� p eel' 6h 52Pfi u " fC s..�. r?
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 #
7nnina to emmnlete the follnwina:
Reviewer to complete the following:
Square footage of Use:
/N
er'itfltted ug-.' � Q ,7� / oIL O /
Under Section:1�/
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /A
Ifs ist:
Proffers:
Y /
IfS6-,-List:
Variance:
Y /IV
If so, List:
SP's:
Y/
Ifs st:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3