HomeMy WebLinkAboutCLE201100180 Review Comments Zoning Clearance 2011-10-10Application for Zoning Clearance
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CLE # Qb1` , 1 (DO �
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OFFICE USE ON
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Staff:
Receipt #
PARCEL INFORMATION
Tax Map and Parcel: c)4 ui34 Existing Zoning
Parcel Own er: \� C,e(L Vr�- I�AN�I
Parcel Address: 180 & S011:71L- e QAQ.u-Z'D City C13AR�`[ X State A" zip Z2 tj 1�
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project ?CId'A \3Ns
Address : 22�13 C.izb.Cw"Cb-4 _ 9 City QV.4Q_k k .' �' %r * -State A Zip a: cit
Office Phone: At L92 Cell # Fax # E -mail
APPLICANT INFORM TION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: D—A)— NiKk',CLLtZ4rr NMI (ANA a RAO —E7' "lc.(--'J'
Previous Business on this site QNgM
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 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 be of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature l C.0 Printed Mm � &Jec_ V Ja f.�✓, f
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 l I (1
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
Intake to complete the following:
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Is us in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will Me 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 r?
If private well, provide Heal p artment 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 u lic sew .
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
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Reviewer to complete the following:
Square footage of Use:
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Permitted as: ( ✓ �✓fi S h
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
YIN
Items to be verified in the field:
Inspector : Date:
Notes:
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Violations:
Y /(
If so; T.ist:
Proffers:
Y <N
If so, List:
Var ce:
Y / IP
If so, List:
SP's:
Y /
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3