HomeMy WebLinkAboutCLE201100157 Review Comments Zoning Clearance 2011-09-12Application for Zonin Clearance
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # -709k Date: 01 _
Receipt # L Staff:
PARCEL INFORMATION L �—�
Tax Map and Parcel: 'Q �fQ,� %'� -� " �� Existing Zoning
Parcel Owner: AjorUrVLP
Parcel Address: %G 5eutiL01,'2 ��l City QN,cr 1, oh +lcf ,& State 0-_1_/ Zip
(include suite or floor)
PRIMARY CONTACT l
�Ct�l, �b I �.�•V! C-055&bZ10PI
Who should we call /write concerning this project?
Address: (0(!201 U) PAbax rjf City )Zic LWvUnj State V4, Zip V57,72:
Office Phone: (� Cell # ( ?>:5 Fax # E -mail C,055d,1011— A,%44 Ieen e,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: A lrmiwCi -V'�
Previous Business on this site ( UywP� G,�S (7?C ?AR
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any dditional informam�tion that you can provide: Fo- od S4(Ar ZZ - j2ro v t A4
i 15 tO ��� -- L J -I
*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 ac c to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
P1__ Printed
Signature L IDItK
APPROVAL INFORMATION
,..•J-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 x— Date r-(/ e
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
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Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use:
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
O/nN
n itted as: GC ,
Y/N
Will there be food preparation?
Under Section: Z,
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Parking formula:
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
Y / N
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to rmmn1P -. the fnllnwinu:
Violations:
Y/
If srlst:
Proff s:
Y/
If so, List:
Variance:
Y/
If so, ist:
SP's:
Y/N
If so, List:
Clearances:
SDP's
z�Cl- 3S
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, Buil(ling Permits) if the application is not the
owner.
I certify that notice of the application, 2 Cs -t
/ [County q pplication name and number]
was provided to /`��/'� ✓ �ti� �rGt� �`^^ the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 4; yO - -' aU' aJ ' Oby delivering a copy of the application in the
planner identified below: /
Hand delivering a copy of the application to / J0, L7'� V jl`f t.y✓'k �V�
[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 9 / %
Date
9k-1
I\� 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].
V VL
ature of Applicant
Print Applicant Name
Date