HomeMy WebLinkAboutCLE201100151 Review Comments Zoning Clearance 2011-11-30Application for Zoning Clearance
0
CLE # 2 N/ ' 6 %
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # v 7 o & Date: 09,17 it
Receipt # e� 5 Staff:
PARCEL INFORMATION
Tax Map and Parcel: D321►O - DO - op ✓04E3oo Existing Zoning f oAic
Parcel Owner: COLUIf1&A Jr 1110&1141"6404441
Parcel Address: 171 4PAWyN" 474e City State A Zip '2211!!
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: 3o7 W I th S7?&-07- City Irvor woor 1 State V Zip 76167 -
Office Phone:(___) Cell # 91? 680 sJ%1Fax # E -mail ,J�rCo�1Ge �Gla�ioo.�.n
APPLICANT INFORMATION
Check any that apply: _V Change of ownership Change of use Change of name L,^ew business
Business Name /Type: !1 #Ar,# W!G/{ Svw *A102 S4"Dwiclirs
Previous Business on this site �y/zArtS
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: - 4A1,V 114# &MMkaR&&M, 2 S#1r -r 4 x#40- rl a
E c�Usr1AJ6- s ly`
*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 e knowledge. I have read the conditions of approv al, and I understand them, and that I will abide by them.
Signature Printed . /O V y R
APPROVA FORMATION
];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 —
j��
Zoning Official ,r Date 4�/= 0 2,)d
r
(_
Other Official' / Date
,'Z--
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /Q
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not be in u til we receive approval from Health
Dept. F*3eDATE 1(
Circle t2on- e that applies
Is parcel on private well ublic waterO
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app
Is parcel on septic or ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. ,
Permit #
i N
ill there be any new construction or renovations?
If n obtain e proper Per. ,it.��
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 16
Y/1 N
Permitted as:
Under Section: ,r 4.2
Supplementary regulations section:
Parking formula: C/
Re uired spaces.
/
ems to be verified in the field:
Inspector : Date:
Notes:
iolations:
l N
If so, List:
Px offers:
lgjl N
"If so, List:
Variance:
Y /l�)
If so, List:
SP's:
Y A N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 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 name and number]
was provided to j C o v�rib a 1� fiou my,40 GGG: the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number o32o0 - ov - oo -0g3oo 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 491o"%bt't jr zz.G
[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 $- is -wll to the following address:
Date
%90 83o 94" ,41t/roAr10 Tit '782"7q
[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].
Print Applicant Name
6 -is -alt
Date
r