HomeMy WebLinkAboutCLE201100193 Review Comments Zoning Clearance 2011-11-14Application for Zoning Clearance
CLE # R-4
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date: J
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: C G 1 w — Cfb - C7y — 0- 3 eJU Existing Zoning
Parcel Owner: 2�o I'rVoci 1 TC-r -1 rv� �TC�UJc %�/�2TnietiS i
Parcel Address: �a /t �-�E �t� �� .�c� City C c 1 - ✓ r 1.L--2 State l A- Zip Z2 gC
(include suite or floor)
PRIMARY CONTACT n
Who should we call /write concerning this project? !eB Cn 7 WA UrC&I
Address: 3 22 L 0" 6 f L A-& /',► D 5-e City C ft ` ✓ f C L'e State Glh Zip 22911
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Office Phone: L_� 29 — S�3 Cell # e Sob Fax # E -mail �w CZC2r ® ��
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:
Previous Business on this 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: jf �,,J P A-0, St-1
*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 conditiongbf approval, and I understand them, and that I will abide by them.
Signature 4q-z� u1i Printed
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 Date
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
_c. C-
A-7
Intake to complete the following:
Is/
Is usW LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /9 tli
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 u Z�E ?
If private well, provide H alt t form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
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 #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7n"mff +n nmminlnta 1-hp fnllnwina-
Reviewer to complete the following:
Square footage of Use:
/N
ermitted as: 3-' /ml
Under Section: Ab,. +
Supplementary regulations section:
Parking formula:
Req ' ed spaces:
Y / '
Item be verified in the field:
Inspector : Date:
Notes:
olations:
N
If so, List: /
Proff
If o,iist:
Variance:
Y/N
If so, List:
SP's:
Y/
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, Z6 V r / 1/3
[County application name and number]
�ALIL iv e,i (r 1 i n
was provided to PA O A'S S °C r A' To-' the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number O Ca (00 — CI CJ L 23 cw 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]
Me,
Date
,,//Mailing a copy of the application to �� 0 A-sSac r=f e n\ kTEV P/3-z r fVe#L r1+
[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 (V?)o z—N L-7,, F 2a i k to the following address:
Date
AA /' 2�Pe n-� r t�-r I nr� � /
l Fjtk q �bZ. �lCl1 ,-N 0 VA-- Z3 Z,7-
[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].
a4,4- ojuz
Signature of Applicant
Print Applicant Name
Date