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HomeMy WebLinkAboutCLE201100011 Review Comments Zoning Clearance`• r Application for town Cl-ear. "an-.ce 0 CLE # V L1 , 0} ?ETCH CJS t?l�lLY f r /9,// X-71,11fl) ing Clenrance - $35 Checit df Date; PLEADM i' ALL 3 SHEETS Iteeelpt df Staff, Tax iYlap and I'nreel; DG (ors oa —12-3012 Lxisttng Zoning ��anne psi�M e P- aroelOwuerr d �55�ct°�ie f{ UA Zip 22 � Parcel Address; 47-o Ake -tmr V Sacw.cc� , � City �or{�SU� Ue state (include suite or floor) pRMARY CONTACT Who should rve califwrite coticerning Tb(s project? 1 d r City C �,tieso 1 la State VA . Zip ZzltaZ. Address,, l l S S �dx c1��t5r �'` `� Office Phone ., [___j____�CeU# .4. L6- -ng2Fax #_ NA ^ � -mail MLU rraaiaS�' CRL �►6 APPLICANT INFO MA'. UIN Check any that. apply Change of ownership Change of use Change of name l'te�ir business Business Name/Type,, • L. -% Prevlous Business on This site Ha w°c k Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of -vehicles, and any additlonaf 1nfOrmati011 that you can provider is -,rP- s °k- �k v. L OVCC Zo U- 1'r C . fA .This Crearame tviil 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; 1 hereby certify that t own or have the owner's permission to use the space indicated on this application. I also certit, that the information provided is true and accurate to the best of my knowled have read the conditions ofapproval, and I understand them, and that I will abide by them, signature Printed APPROVAL TNF{`ORWA.TION' Denied ]Approved as proposed ( 7 Approved with conditions L ) Backtlow prevention. device and/or cuffent test data needed for this site, Contact ACSA, 977 -45I I , xl 17. [ ) No physical site inspection has been done for this clearance, Ttlerefore, it iS1rQt a determination of compliance with the exist+ng site plan. [ ) 111is site complies with the site plan as of this date, Btriidlnng Official S�,i4 7� � -�=` -� �°'`� Date Count, or Albemarle opartment of Cwnmtruft�1i l)edelopment 403 McIntire Road Cllarlottesvilie, VA Z2902 VOIcet (434) 2p6-5832 evised 04128/09, 4 72 -4 (19 Page 2 of 3 Intake to complete the following: Reviewer to complete the following: Y / b Square footage of Use: (© / Is use in Ll, 1-11 or PD1P zoning? If so, give applicant a Certified (�) / I� ' Engineer's Report (CER) packer. Permitted as: -/ N Under Section: 1 ill there be food preparation? �i If so, give applicant a Health DepaiimenI form. - - Zoning review can not begin until we receive approval from Health Supplementary regulations section. Dept. FAX DATE � � � 1►1 l' Circle the one that applies Parking formula: Is parcel on private well or p Hater? If private well, provide Health Department fonn. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE 1' � , Circle the one that app] ie Items to be verified in the field: Is parcel on septic or bIi er? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit, Inspector : Date: Permit # Notes: Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Violations: Proffers: Y/N � / 1\1 If so, List: If so, List: Valve: SP's: '/N 1/ If so, List: If so, List: Clearances: SDP's �vr i Revised 04/28/08, 10/13/09 Page 3 of 3 G`/laf`o�7eSVi1�C VA (O Z- 3i i�rona Doo! N 0 V �O Ndn��ee.a $eartn.J t„�a1� /� r S u �I t Z+ 3 w N 't34��coov� k- --'- -�"'�1 ��� °� c•� ��,c1 ?�ten� Fbx �I oe; to- 101 (�] o� A-o S c..le ADA q,S 1af1,!� CAS �� �oS 1` 5 renic �o D+S,nlovwl �C4