HomeMy WebLinkAboutCLE201100020 Review Comments No Submittal Type SelectedApplication for Zoning learance
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CLE # �J ll �f
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O Y
Check# cS Date:
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: ► vl Existing Zoning IjI
Parcel Owner: 1�rxes+ LaVC5 shoe's oe'ss i
Parcel Address: l 10 > >r ��e� �r��� �r,1. City &h( lay 63 (k State �I/T Zip zz91 I
(include suite or floor)
PRIMARY CONTACT
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Who should we call /write concerning this project?
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Address :1270 6aL 0/1' Svr�'�/ city f v, State %2 Zip 2Z %lI
Office Phone: ( `�) 7�� y Cell # Fax # 7 ?,V Sa/E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name/Type: G41.1�114 f /' C. Q-or
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Previous Business on this site �FCZ g :j � J34—JVI
Describe the proposed business including use, number of employees, number of hifts, available parkin g spa es, number of
vehicles, and any additional information that you can provide: ,/-� /ae -1' Z. — fzC
*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 accurat I the b of ow edge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Sign at a Printed
APPROVAL I FORMATION
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 f
Zoning Official 4Za 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:
Y(D
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
MOOS
Will there 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 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 ap
Is parcel on septic okpublic sewer.
VIN
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: 'd►l �) OdjC�
er it
Perm r rj;1
Pitted as:
Under Section:��, Z• I
Supplementary regulations section:
Parking formula: 'Sh6rolkI b/
Required spaces:
Y/
Items be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so, ist:
Proffers:
Y/
If so, t:
Vari ce:
Y/
If so, List:
Y
SP'42st:
If
Clearances: n rl
SDP's
Revised 1/1/2011 Page 3 of 3
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