HomeMy WebLinkAboutCLE201100156 Review Comments Zoning Clearance 2011-09-09o�
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tlon for ZonhI . Clearance
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CLE # i 80 � ro
PLEASE REVIEW ALL 3 SHEETS
OFFICE U +'O _ ' �I
Check # Date:
Receipt # Staff: LA14 aC au.-".'er-a
PARCEL INFORMATION 2 n �� !
fJ 2 Zonin I
Tax Map -and Parcel:. ✓.. . __ ____._Bxisting _
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Parcel Owner•)
Parcel Address: &az&:z444. & 'S city . tate �� Zip
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(include suite or floor) /'—
PRIMARY CONTACT
Who should we call /write concerning this p Q/ Lac.
/roject?
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Address: Ais -�'" 0''^!61 City State /r'r7 Zip
Office Phone: ( ) Cell # E -mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name =New business
Business Name /Type: ?
Previous Business on this site `
Describe the proposed business ineIuding use, number of employees, numb e of shifts, availabrle arlcing spaces, number of
vehicles, and any additional information that you can provider
*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 th 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 owl dge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed &grAr— (.11A
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 Date
Other Official Date
1 I UUIILy OI LilUelllarle 1V=Fiu uucue V va1LAAAU .Y Lr.wvl..........
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 1/1 12011 Page 2 of 3
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Intake to complete the following:
Ln Is I, HI or PDIP zoning? If so, give applicanta Certified
Engineer's Report (CER) packet
�Uiei e be food preparairon7
If so, give applicant a Health Department-form.
Zoning review cannot begin
��until l we receive approval from Health
Dept. FAX DATE 2Z • % --
Circle the one that applies
Is parcel on private well o public water?
If private well, provide Health Department•form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
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Reviewer to complete the = following:
Square footage of Use:
IN
ermitted as: ` r�
Under Section: 2- LJ
Supplementary regulations section:
Parking formula:�M
Required spaces:
Y�
Items to be verified in the field:
Is parcel on sep rc or pu rc sewer.
Y/N .
Will you be putting up a new sign of any kind? If so, obtain proper -
Sign permit.
.Permit # Inspector: Date:
Y Notes:..
Wrl :t ere be any new construction or renovations?
If so, obtain the proper Permit..
Permit #
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v
Violations:
( N
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If so, List;
offers:
V/ N
If so, List:
Varia ce:
Y /
If so, 1st:
�I"s:
N
If so, List:
Clearances:
SDP's
/
Revised 1/1/2011 Page of