HomeMy WebLinkAboutCLE200800010 Legacy Document 2013-01-03i
Application for����
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Zoning Clearance
OFFICE USE ONLY J % 0
El Zoning Clearance = $35 CLE # -
PLEASE REVIEW ALL 3 SHEETS Check # Z Z717 Date: I -I T 0 9
Receipt # 6, 9 5`7 9 staff. be IQ ._
PARCEL INFORMATION
Tax Map and Parcel:
061UO 02 00 00200
HC
Existing Zoning
Parcel Owner: Berkmar Park L L C
3000 Berkma;r Drive Char 1 ottesvi 11 e State Va. Zip 22901
Parcel Address: City
(include suite or floor)
PRIMARY CONTACT Robert Jones
Who should vfe call/write concerning this project?
Address : P 0 Box 353
City C a r l y s v i l l e State
Office Phone: (_) Cell k34�963 -7668 Fax #
E -mail
Va.
zip 22936
APPLICANT INFORMATION
Business NamdIype: P , DBA:. Rooter Man Drain cleaning
Previous Business on this site Commonwealth H2O
Describe the proposed business, including use, numb^- nf employees, number of shifts, available parking spaces and any
additional information that you can provide: 3
*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 t � best of my knowledge. I h the conditions of approval, and I understand them, and that I will abide by them.
Signature
Printediha7-
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, x119.
[ ] 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
Zoning Official
Other Official
Date -S- I,:) 1t
Date X)
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
e
t
Intake to complete the following:
❑ YES Z NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES V NO
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
❑ YES ❑ NO
Is parcel on private well Cr ublic wat ?
If private well, provide Health ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES ❑ NO
Is parcel on septic public sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
❑ YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning Tech to complete the following:
Reviewer to complete the following:
Square footage of Use: 1 -7
,0� YES ❑ NO
Permitted as: Lqq -LI C 7 `,
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: y
❑ YES ❑ NO
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
❑ YES,,❑/ NO
If so, List:
Proffers:
❑ YES NO
If so, List:
Variance:
❑ YES [� NO
If so, List:/
SP's:
❑ YES /21 NO
If so, List:
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