HomeMy WebLinkAboutCLE201100188 Review Comments Zoning Clearance 2011-11-08Application for Zoning Clearance
9
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
JReceipt#
Check # Date: 111312'11
h `/ -7 ,3 Staff. A G
PARCEL INFORMATION
Tax Map and Parcel: --1' `rI / -1-3 B Existing Zoning Fb MC-
Parcel Owner: P 1AA Fin an ( 1QI 'Pro�an
Parcel Address: 159 l-$ Aq --x- -n Fri - % tl'Pe 2G% City t^ ht v i Lie e State V A Zipaaal i
(include suite or floor)
PRIMARY CONTACT
_
Who should we call/write concerning this project? Fln -b,
Address: 15 t J+rnsen RA- SuI-Ve W2 -b City Ile State \l'.A Zip?-29'1l
�� .90
Office Phone:) 7 `� C6 -29 0 Cell �Lh34)21 Fax # 434 2 G2,2� E-mail 43Q6., r-Arnr7il.
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
ChCtthgqe CFa, � C -5
i PXIuc, P,1c
Business Name /Type: rrq F 1401r-r. FIX). C1 in tccL1 F5gAa,lt le
Previous Business on this site 1.11 Pr
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: l'VQ12 t�rczciir - �1 t n Qs&.c cy -czc$e e
*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 my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature MA t'l�" � Q_t n � p l) .17 Printed I
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Baclflow 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 [(1L( ( (
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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y/
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Wil ere 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 or
;7 ter?
If private well, provide Hea pa ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or lic sew
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 #
Zonin2 to complete the following:
Reviewer to complete the following:
Square footage of Use: 10 n S ct . -' e- e— .
Qrmitted / N 0 C, as: ' i �v-� 6 t G<✓
Under Section: . �L
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N 1/
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y
If so, ist:
Roffers:
/N
If so, List: 4
I?M4 2vo Z
Va ' nce:
Y/I
If so, List:
SP's:
Y/1
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, Zc n m
[CounV application name and number]
was provided to Flml y C rc) re-r ltes , �-LC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number - -I ? 17 3 R J 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 F 1✓1^ Fr•o Pc2'r lup
[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 No 41.1 , "Z O 1 '1 to the following address:
Date
115"1 j- wN-,&,n Rci . 01,c,,,1o+4-es•y 111 -e, V A 2- 2S'I1 (S 2(32-A
[address; written notice mailed of 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].
9e
Signature f Applicant
l�rr.j P. 1.(I r s11 r ►TF' h D
Print Applicant Name
I i -01- 11
Date