HomeMy WebLinkAboutCLE201900086 Approval - County 2019-05-30Application for Zoning Clearance
CIE #
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OFFICE USE ONLYr
"
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: p Q(�—�� -� - Q Zp�� Existing Zoning it,
Parcel Owner: [ clk41 (51" k V"U e1 7�\ 7 uu—
Parcel Address:Zls I l tW lCt VLt- - 121 City O i Z l[ ' State. Zip ZZO
(include uite or floor)
PRIMARY CONTACT f\
Who "IAA NC
should we call/write concerning this project? C4 LA� --J� LaX-9-
t� 1`1 �
Address: z� ` �G� �. c4City f:5,(_6A l U State ZipC%qj6z(
Office Phone: &J C(q Cell# Fax#E-mail \iGCy�.CIInGt�li�lCL41(�
u a.vv, e vi c. l t try.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name VNew business
Business Name/Type: Ej J8 ci ki t",P_ Q 40evic6L RA (} VfA Cl� �c,
,(
Previous Business on this site H 7
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: W*()V nazi e- Leoa-lin
G- cs
t If
*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 permis ' o use the space indicated on this application. I also certify that the information provided
is true and accurate to the y k e ve ad the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed �,L t 1 LPL k, at S
APP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ Iiackflow 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 detennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes
Building Official L pate
Zoning Official Date IS
Other Official Date
%.vunty or AIDemarie Impartment of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 1 1 /02/2015 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 zon/nepplicant a Certified
Engineer's Report (CER) paOen-nitted
/ N
as:
Y/N
Will there be food preparatiUnder Section:
If so, give applicant a Healt.Zoning review can not begiapproval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applie Parking formula: n
Is parcel on private we or public water? �(
If private well, provid health Department form.
Zoning review can n begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/N
Circle the one th applies It ms e verified in the field:
Is parcel on sep c or public sewer?
Y/N
Will you be utting up a new sign of any kind? If so, obtain proper
Sign perm' .
Permit #
Y/N(
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
ZoninE to complete the following:
Inspector:
Notes:
�1(UUN,Ld
Violations:
Y/N
If so, List:
ffers:
rpTY/N
f so, List:
% , 63
a {
Variance:
Y/N
If so, List:
-
SP'QN
If
If s,t:
Clearances:
SDP's
Revised 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 (Home 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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
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
E�6Mailing a copy of the application to 7—a l o f lvx0 0-�
[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 ) to the following address:
Date
Z1 IZT- voc-L-A W
ie—.
[address; written notice mailed to the owner at the last 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
44g kok
Date
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