HomeMy WebLinkAboutCLE201100142 Review Comments Zoning Clearance 2011-08-02Application for Zoning Clearance
CLE # Zd I `` 42:
�I /71i1N1P
OFFICE USE OILY
106
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff: J
PARCEL INFORMATION - - -- - - - - - - -- -
Existing Zoning P SCE
Tax Map and Parcel:
Parcel Owner: toSE NTHAI- PLOP RD EL-S U,(
Parcel Address: •AeZ) PAO 141 L�V CF-NM) City GN H-P_Vp1 9VLC( State YA- Zip 2 -ool
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? K%LD H N A- 1 AC,2_M A-KEk-
Address : 9'q'9_ M N 'TZCU- R0Af City pAN V I irk State Ufa- Zip 2, s
Office Phone: � 5k5 bk35 Cell # X $$ 5��W5_ Fax # E -mail k_41-CLM- -[?.Ee- L
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: � A Y ( ZS RED W H P f- NY QEb M N G &ND �%t T �� SS (Ix `� t (-M
Previous Business on this site D0VA'1 'jZE-5
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: 2 Ew WY EFS 2 S 1 t i FTS 2 VE K I CGes (_o1,J ,
*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 Printed Lt� LA N A- VjA -C2. -M 6-P t__L
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 i
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:
Is / �N
Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /�
- _ - -- -
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 Cublic at er? If private well, provide Hea form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that Z ies
Is parcel on septic publiDsewer?
Reviewer to complete the following:
Square footage of Use: ! 6U0
aN
itted as: nn
Under Section:
Supplementary regulations section:
Parkin formula:
l
'Required spaces:
5
Y/N
Items to be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. f�
Inspector
Permit # I� V
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # i SP
Zoning to complete the following :,.,
Date:
Violations:
Y/N
If so, List:
ffers:
Y N
so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances: t �
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,
[County application name and number]
was provided to RD,Sl: N i kAti f •WPE, �- t ES L Lc- the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
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
V Mailing a copy of the application to PAS E N) 1-iA --t- ?VO Pl;�-Tl E S., (.LG
[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:
0_�P C9 u2;FH ous C { OA-P , S iT 3'x,0 . U t E N W A- , 'VA- 2-V92-
[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].
Signature of Applicant
k *Z0VI l\f i} rA-c2 N A-P"e
Print Applicant Name
q-I �A
Date