HomeMy WebLinkAboutCLE201100187 Review Comments Zoning Clearance 2011-11-08Applicati ®n f ®r Zoning Clearance
CLE # ZO r
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 4-12-4 Date: '� 7
Receipt # Staff: Mf
PARCEL INFORMATION
Tax Map and Parcel: 0"A cSoo' -- �30 . 00 ~ (� �' Existing Zoning G "
Parcel Owner: a-Qe — ni-e �- ,
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Parcel Address: \p01 �w�lY1b�Y�1 Sy�%e2,D'L City � � State � � -zipAt),
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(include suite or floor)
PRIMARY CONTACT ^� a
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1,
Who should we call /write concerning this project?
Address: OX �� City�k' A6 , Stan✓ Zip
Office Phone: �� Qcr I ! 44- Cell # Fax # 8zg3S E -mail G OA (fib y- (( l' 0-n
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use IF Change of name New business
Business Name /Type: C ��
Previous Business on this site =P-
Describe the proposed business including use, number of employees, kr 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 r a the er's permission to use the space indicated on this application. I also certify that the information provided
.is true and accurate b my nowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature _ Printed _ 2�
ne 7 17
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.
[ ] N physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site pl.
[ ] T is site complies with the site plan as of this date.
Notes:
isuilding Official Date (f t �J t t
Zoning Official 41 Date a&Z%
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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y/
Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /�tere
Will 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 or ublic w r?
If private well, provide Heal partment form -
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl' s .
Is parcel on septic or p c sewer
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: �J
M/N p
'Permitted as:
Under Section: 2 2
Supplementary regulations section:
Parking formula: _
Z v�
Required spaces:
Y /
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y/&
If so, List:
Proffers:
Y/
If so, rst:
Vari,a cg :
Y id
If so, List:
SP's:
jP / N
If so, List:
Clearances:
Revised 711 12011 Page 3 of 3
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