HomeMy WebLinkAboutCLE201900008 Application 2019-03-07Application for Zoning Clearance
CLE # a Q
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # W� (' Date: /l f
Receipt Staff: G5
PARCEL INFORMATION
Tax Map and Parcel: QW /YQ - 00 - 0C"302, oQ Existing Zoning i4hwnd m4l a
ell 00hi 1)jwjyrh
Parcel Owner: V e_ rd $
Parcel Address: 6 Ift iL JA 11 City ✓l Ilutate VI , Zip ,09al
(include suite or floor)S;,ieA30Z,
PRIMARY CONTACT :�afyl4c
I I) p LSOL
Who should we call/write concerning this project? mil/ l� C,R-
- I q I Cl Iewom rq"ONIA City ��State V f^CAddress:Zip ,2:290/
Office Phone: ( 'Q Cell # Fax # E-mail � n � � 1.Zwee • CW L
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:
Previous Business on this site
Describe the proposed business including use, number of employees, numb r of shifts, vailable parking spaces, number of
vehicles, and any additional information that
you can provi e: 8 S Q
n Q A 's Ss C rn VE
*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 acc ate to the est of y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed�Ayde,l
APPROVAL INFORMATION
Approved as proposed [ Approved with conditions ] Denied
j Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x 117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
I J This site complies with the site plan as of this date.
Notes:
Building Official �� Date
r
Zoning Official Date f-16 //9
Other Official Date
t-ounty of Amemarie Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y N
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will ere 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 blic w er?
If private well, provide Healt rtment 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 pu ec s er?
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 complete the following:
Reviewer to complete the following:
Square footage of Use: ' D
N
ermitted as: C�
Under Section: ZM
Supplementary regulations section:
Parking formula: I gw i'L
Required spaces:
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Vio ► s:
}
If so, ist:
offers:
YY / N
I so List:
Varie:
Y N
If so, ist:
's:
/N
f so, List:
Clearances:
SDP's
f�
,
Revi sed 11 / 1 /2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Horne Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, kQ(\ C n
[County application name a6ld number]
was provided to V Qil ( (i�/I'le01 ?P,0,066� e5 the owner of record of Tax Map
[name( o the record owners oft e parcel]
and Parcel Number N I NQ - Q® — OC 200 by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on
Date
Mailing a copy of the application to 66 2QW&S
[Name or the record owner if the re ord owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
on I I `I I (q to the following address:
Da e
Zol 15--�1 A - 6JAsville, VA 2-Z903
[address; written notice mailed to the owner at the cast known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of Applicant
Print Applicant Name
Da e
F1 oog- pLa n -FoE 9'4 / C Ient,4-�
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