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HomeMy WebLinkAboutCLE201100177 Review Comments Zoning Clearance 2011-10-07Applicati ®n for Zoning Clearance 0 OFFICE ONLY 3 PLEASE REVIEW ALL 3 SHEETS heck # ate: eceipt # Staff: PARCEL INFO 'I 6lQl A b- m--W & C 1 uM -�1, Tax Map and Parcel: "' Existing Zoning Me_ Parcel Owner: Kan � L1_ , t , Parcel Address: 7io f��� • City c V State A• Zips �9d (include suite or floor) PRIMARY CONTACT Who should we calll concerning this project? K /write J Address : 4� © / h11lYV�(.OJI a • City in" in"d& State i- Zipa a X01 Office Phone: q-7-3-:3 Cell # Fax # q73 -06 ge E -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business 41_J�A^41 y Business Name /Type: Business this _ , 0<5 i c)/i i Previous on site 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: 1_ `-Enc, Cd� *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 brst of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Printed J Signatur 1 APPROV ORMATION 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 Date (0 / f Date Zoning Official 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 Intake to complete the following: Y / Din Is LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Wil re 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 o;p'u ~ic ter? If private well, provide He th irp ent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that apLie Is parcel on septic or s we er? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ZoninLy to comDlete the following: Reviewer to complete the following: Square footage of Use: 0/ N Permitted as: Under Section: SC-' Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y/N If so, List: Pros: Y/� If so, List: Variance: Y/N If so, List: SP's: Y/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, O L21 Mo' ou —co — C)()3��V [County application name and number] was provided to LL C the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number ma identified below: by delivering a copy of the application in the Hand delivering a copy of the application to L. L [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 /0- tI I Date Mailing a copy of the application to L L [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 10-6—(( 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]. =nj9k e,4 Signature4f Applicant I k Print Applicant Na /me � � 1 Date