HomeMy WebLinkAboutCLE201100130 Review Comments Zoning Clearance 2011-07-26Application for Zoning ClearanceJi
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OFFICE E O IYLY
Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt ;4 Staff:�i
PARCEL INFORMATI91�L _ �� /1 /fin
�-j- `�(; �'I' Existing Zoning � 1�
Tax Map and Parcel: _
Parcel Owner: \"- C I is, el `r`zmaj� -
:
�gj�j-I 5.eAA' n.O�.L �(U� city � State Z.Ih�
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Parcel Address: Y
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concernning this project?
�� \ t)� City �'S`�`�Q _State V V'� Zip t�
Address:
� �✓ •
# E -mail be`S
Office Phone: L� Cell J-� ax
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use�p Change of name New business
_
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Business Name /Type: i, XN' � l " ��iO� A
Previous Business on this. site-
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 anew location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best 4 my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printe
APPROVAL INFORMATION
pproved as proposed [ ] Approved with conditions [ ]Denied
[ ] Bacicflow 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 Date
Other Official Date
County of Alnemarle UeparLMWI u1 %,uultuuluLy "V V c vim,......
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 /0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Will4re be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applies ���
Is parcel on private well or 11u�''b'lier4r -a er?
If private well, provide Health De rtment form.
Zoning review can not begin until we receive approval fi-om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or pnlrlic-seWe—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 #
7.nninor to rnmrilata tha fnllnwinu!
Reviewer to complete the following:
Square footage of Use: ) I(.) D
/ N
Permitted as: :Cilibvr —
Under Section: ZJ� 7--
/
Supplementary regulations section:
Parking formula: P
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
V'olations:
Y N
If so, List: � / f n
Proffe §�:
Y/N)
If so,'"`"���ist:
Varian e:
Y/
If so, List:
SP's :.
Y/D
If so, List:
Clearances:
SDP'
Revised 1/1/2011 Page 3 of 3
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