HomeMy WebLinkAboutCLE201200010 Review Comments Zoning Clearance 2012-01-23Application for Zoning Clearances��'
CLE # 0
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OFFICE U E O Y
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PLEASE REVIEW ALL 3 SHEETS
Check# l� Date:
Receipt # Staff:
PARCEL INFORMATION Q ,p
Tax Map and Parcel: I`' o-p Q)O '•L[)r9pco - Cx) -D(>— 007 0� Existing Zoning
Parcel Owner: �! !'i'1 �� j`�`{f5 P S ,
Parcel Address: � 0 1 0,1 ,qo iC City State Zip a `f
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 0 !
Address: 101 Q �YGt-1'1 �c. i t /1 �5 • City �,ZM04 ()dLI) State Jp�- Zip Z 2
Office Phone: ( 0q) - r Cell # Fax # Y' q-q0 E- mailUi ALq . 1�6�114�
APPLICANT INFORMA ON
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Joe iA 1"r
Previous Business on this site lfP�JW 1 L�
Describe the proposed business including use, number of employ, u ber of s ifts, 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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature _Atla, 3 Printed 1 0�,I f'Jl
APYROVAL INFORMATION
[L] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bjpkflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ o 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
Zoning Official I' Date
Other Official Date
County of Albemarle Department of Community llevelopment
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:
Reviewer to complete the following:
Y / N
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Permitted as:
Y/N
SP's:
Y/N
If so, List:
Will there be food preparation?
Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well or public water?
Required spaces:
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
uvaa aaa
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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Note: This map is fordisplay purposes only
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v See Map Book Introduction for additional details.
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