HomeMy WebLinkAboutCLE201100016 Review Comments Zoning ClearanceApplication for Zoning Clearance
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CLE # 'Z Q l I — J
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OFFICE USE fflLY Z I
PLEASE REVIEW ALL 3 SHEETS
Clieck # Date:
Receipt # Staff:
PARCEL INFORMATION ` 1
`
U�� CCU ��lL� Existing Zoning I
Tax Map and Parcel:
Parcel Owner:—':—OA-126, Z' L L
Parcel Address: 33 IS— 6 s r- Krnu;r D City Eke r-1 o'je5V; j 1F State V4
(include suite or floor) 374
PRIMARY CONTACT
► ��' C`^ �' �'Y`�Y
Who should we call /write concerning this project? 1
Address: 0a A, 1 ��
Office Phone: I' (7- 5-- g3ce11 # tea' -V& 'F'-ax # 7 E -mail do wn P-Y"
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: /Mgri,i2io � ,c (Ae
Previous Business on this site 2
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: 7�1%E°GF 042`,4 ,� Ie 5 4- ..S er tai CO
1-n - ,O= RL n r;L a n )"
-9-5-
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move he use to a new location, a new Z
Clearance will be required.
I hereby certify that I own or have the owner's percussion to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my�knowledge_. II have read the conditions of approval, and I understand them, and that I will abide by them.
Signature /��� IGG.rJ /L (J��i� -��� Printedr� ��,�P_. C� ✓l �-��
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 % /—S 1 (I
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
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Intake to complete the following:
Y / 0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /I 10
Will there 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 ubl' 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 applies
Is parcel on septic or p bb i ,. 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 comDlete the followine:
Reviewer to complete the following:
Square footage of Use: %,3
�b/ N
Permitted as: i
r CSC
Under Section: Zc
Supplementary regulations section:
Parking formula:
Required spaces:
Y
Items to be verified in the field:
Inspector : Date:
Notes:
Viol ' ns:
Y/
If so, ist:
Proffers:
Y/
If so, ist:
Varia ce:
Y/�
If so, 1st:
Y/
If so, \-T-/. st:
,y
i,
Clearances: q f %�
SDP's✓ o[f
Revised 1/1/2011 Page 3 of 3
.14
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