HomeMy WebLinkAboutCLE201100167 Review Comments Zoning Clearance 2011-09-20Application for Zonin Clearance
CLE # t
°Y
PLEASE REVIEW ALL 3 SLEETS
OFFICE USE ONI
Check # "1 Date:q I q
Receipt # %q Qa2, Staff:
PARCEL INFORMATION WW-00-00- D c�Ho
Tax Map and Parcel: /J Existing Zoning
Parcel Owner: &t4l (l/ 1 kld �fr�
Parcel Address:- I �1 `/- //affil City ��(' IG State VCC • Zip
(include suite of floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: ` N ( '(/O 01- Dri of City I , �� GCS State Vl�-•
Office Phone: b -0%fA) Cell # q14 4* 1 Fax # — E -mail
Cap
APPLICANT INFORMATION
Check any that apply: of ownership Change use of name New business
pC//hangppe ��o��f// �� ,,—Change
Business Name /Type: �t'GeU(,�l'%� k-7 ln9
Previous Business on this site Cori veil) 16n_6 _6 �;40(U
Describe the proposed business including use, number of employees, number of shifts, available p king spaces, number of
vehiclgs, and an ,additional information that you can provide: �/(%G
*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 acc e to the best o1,71luiL ledge.. Ihave read the conditions of approval, and I understand them, and that I will abide by them.
Signature �i Printed r n'a (_, . � ✓ Il��i duKli
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 `' ,,, c_ Q Date `1 ( 1
Zoning Official . Date )a1 /z_
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 7/1/2011 Page 2 of 3
1.
Intake to complete the following:
Is .
Is i1seln LI, HI or PDIl' zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
N
ill there 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 o private well or) public water?
If private well; p ovide-Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the ona applies
Is parcel on eptic Or public sewer?
YO-ouWi be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wil there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninu to emmnlete the fnllnwing:
Reviewer to complete the following:
Square footage of Use:
V/ N
Permitted as: czll„ 4 �
Under Section: /0 1
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y /I�
If so, ist:
Proffers:
Y /lD
If so, st:
Variance:
Y/I )
If so, List:
SP's: .
Y/A
If so, ist:
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, 2nal'Y4 `'kn CC.j ,} ,
��%%��,'�� _�// [C unty application name and number]
was provided to ���� K- d I.FJ �1UIG %L(i the owner of record of Tax Map
[nam of the record owns s of the parcel]
and Parcel Number 1 04Ct) — 0 — tV"®) 4i4Q by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to
[Name of the record own r 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 to the following address:
Date
[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].
Sign ture of Applicant
0+rY
Print Applicant Name
Date