HomeMy WebLinkAboutCLE201900057 Application 2020-03-27.11APPR,)VEL0
3._ ,q Application fo Zoning Clearance
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zet` CLE #
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`�RGIN«
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date: ZS '
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 1 ' 7i d C Existing Zoning (D
Parcel Owner: W/ (t �C Pcl, ES:
Parcel Address:, kNt V- (9 eLk 61-4 UV-- City CVI UC-- State ✓ 1 Zip Z7,91
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? L.ANW9 �-N (\0 Nett\J
1
Address: 9150 �ti�i� l.� �� 1 VC City C'VI L-C C— State V 1 o Zip 2 Z 1 )
Office Phone: `r � - Cell # 1 `��. Fax # Z ' C��� E-mail LDN.? 0a V1 ✓11G1 ���./
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: KutAcle -I.lA 1 ' MKALI (al f A Z A-V---r Q)U, -CAIGN t)(= L11TA
Previous Business on this site \,'gyp K- LC--l-�,,
Describe the proposed business including use, number of employees, num er of shifts, available parking s aces, number of
vehicles, and any additional information that.you can provide: ✓ -I L(
-y-a LA AA 4 j7,A,1 ,
!S Q ,; Y
*This Clealance will only be v lid on the parcel for which it is approved If you change, intensify or molve the use to a new locati , 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 bne my owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature V i-� Printed (- (n
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 djy/z?/ i Date
Zoning Official Date
Other Official Date
t_.ounty or Ainemarie 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 use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wil 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 ublic 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 t t applies
Is parcel oritfeptigor public sewer?
Y ON
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Wi (here 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: 15, 1� rc� 0
Y% / N \
Permittedas:
Under Section:
TZ
Supplementary regulations section: n /�
Parking formula: I
rltf �7'�t e eI
Required spaces:
Y/ j
Ite o be verified in the field:
Inspector:
Date:
Notes: /
Violations:
Y/N
If so, List:
Proffers:
Y)N
so, List: Z, A ()! _ (5
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
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, T O'A i VA CJ-�A YEI. V1 U
[County application name and number]
was provided to X�E je i U �j to t,%A Im"Nc—n o r\ '' the owner of record of Tax Map
[name(s) of t�e ord owners of the parcel]
and Parcel Number �{ I 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 -- L \ A -" Uk Pi 0 fPc7r U1U
[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 ! I Zi J 1 Gq�
to the following address:
Date
h (�d Y LA c' V z t T, 0 t k 13 o ft (Et'-.j NSA 0 P a r NT�� , Gt/I Lt C-
[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
Date
I