HomeMy WebLinkAboutCLE201100148 Review Comments Zoning Clearance 2011-08-17Application for Zoning Clearance�_�
OFFICE p4E O LY
`-
PLEASE REVIEW ALL 3 SHEETS
ee" Date:
Receipt # Staff:
PARCEL INFORMATION ++ r ►.0 �j �f11r
Parcel: I m 12 ' Existing Zoning ryj
Tax Map and (p
i
Parcel Owner: t, 66 , 1.) e WnI rj l—Ll 4D IZ �iW l %r�.6 "UFO A W ` •
-F
Parcel Address: 4-%! l =ELJ A (J • City akoy()`4 w k State V n ZipGC' ►b
floor)
(includes ite or
PRIMARY CONTACT
Who should we call /write concerning this project9
a
Address : ` 91) 12[U5 I i � � City State _VA Zip726td
Office Phone: AA 0194 - Y IDD Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
CC��
Business Name /Type: � 1)0,, M �1r7/�. f )
Previous Business on this site c e e oti wJ abyy/
Describe the proposed business including use, number of employees, numbers� off shifts,, a /vailable parking spaces, number of
vehicles, and any additional information that you can provide: W A �i'1„1 I V
*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 zy knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Lb L74 Lf
APPROV,kLANFORMATION
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 Date l ( d
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 1/1/2011 Page 2 of 3
a
Intake to complete the following:
Y /'6
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a. Certified
Y/b
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well of public w r?
If private well, provide Hca fli epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl
Is parcel on septic or is sewe ?.
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
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:
Oen-nitted N
as: SnR
Under Section: 2S i
Supplementary regulations section:
Parking formula:
P1 S y
Required spaces:
Y/
IterKs to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y /`N'
If so, List:
Proffers:
Y
If so, List:
Variance,
Y //I ^
If soy`,-- ist:
P's:
(�' / IN
If so, List:
Y ��X
Il —!
Clearances:
SDP's
Revised 1/1/2011 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,
[County application naive and number]
In
was provided to r% a V y--) ip)w i YAW the owner of record of Tax Map
[name(s) of thd iecord owners of the parcel]
and Parcel Number (D m ` ` ` l./ by delivering a copy of the application in the
manner identified below:
� Yr� rr
[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
[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
to the following address:
[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].
Signa re f App ' ant
Print Applicant Name
Date