HomeMy WebLinkAboutCLE201100181 Review Comments Zoning Clearance 2011-10-10Application for Zoning Clearance
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CLE # ,a C)1 1 001 � 1
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # c1b Date: 1 Q ` �� ° 1
Receipt # Staff:
PARCEL INFORMATION 3LANM60
Tax Map and Parcel: Q1' 2'�k Existing Zoning SN, OAUltJ& C�nrC
Parcel Owner `kQP4J%4
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Parcel Address: %3315 U%1*14M C%RCy_ City State y% Zip "Z,tgo
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 1— \I P iA kft— 1t11a"
Address : ZtA Q4QJk=1%9J %Lp City y9itk.s�rZ" ,YiUlz State J' r Zip `ttgo'Z
Office Phone: k.XSJ Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: 1,f Change of ownership Change of use Change of name New business
Business Name /Type: 4`_ N0,40 e4w, C An- W ns N) C4 Nl\kL_ t a1 MIL
Previous Business on this site C- t-ASS1 Qer . W A+-Ty�
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 permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my laiowledge. I have read the conditions of approval, and I understand- them, and that I will abide by them.
Signature l to Printed 1�11['l�.i�.10..�%+• UJwI J 1Wn IZ V6 AU-fA
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, xl 17.
[ ] 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 1-0
Zoning Official Date
Other Official Date
County of Albemarle Department of Community I)evelopment
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/-I�)
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/
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 o ? is w er?
If private well, provide HeVWjDeKrtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or pu sew r?
Y/N
Will you be putting up a new sign of any Icind?
Sign permit.
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
0/ N
Permitted as: WPtfi
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/
If so; List:
Proffers:
Y/0
If so, List:
Variance:
Y/C)
If so, List:
SP's:_
Y/(
If so, ist:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3