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HomeMy WebLinkAboutCLE201100209 Review Comments Zoning Clearance 2011-12-21e Application for Zoning Clearance 0 OFFICE USE O Y Date: %�2,,�2d ' PLEASE REVIEW ALL 3 SHEETS Check # Receipt # G Staff: t PARCEL INFORMATION ] r Tax Map and Parcel: % — ck f CO— 1 Existing Zoning qq I ( �/� Parcel Owner: -i�e (,'t r1 � � ��r / �i� �� L"_ (f-, Parcel Address: ! 03-6 " �h►`;� J c bnc` City C_A t r) dh State 1,4 Zip (include suite or ft r) PRIMARY CONTACT r ` Who should we call /write concerning this project9 Address : *;:'3 "r 5kd r?'5 Rd.- City Fx C m r-4\ State Zip 2 2 UD Office Phone: v7 W' _ f � ell #' R- 53 2; l F2 # E -mail +J}'[ Y('1'"C 0 © I �' APPLICANT INFORMATION Check any that apply: Change of ownership _X Change of use Change of name New business r r Business Name /Type: Previous Business on this site �V �, I i�l_( �.1✓ Describe the proposed business including use, number of employees, number of shifts, available asking spaces number of .pJ vehicles, and any additional information that you can provide: *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 bes of'4 ny kaowle ge -I -la ve read the conditions of approval, and I understand them, and that I will abide by them. k Signature Printed o iL 1 t' o l� �. ►� r PPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Bacicflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 17. [ ] 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 ✓' ' ' -�". -� w� Date z - Zoning Offic' lo Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126 Revised 1/1/2011 Page 2 of 3 -' PY[ + tr e Intake to complete the following: Y P Is usLI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / Will t sere 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 If private well, provide Health Department form. Zoning review can not begin until we receive approval fi•om Health Dept, FAX DATE Circle the one that appl Is parcel on septic o public sewer9 Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. W ( ( / IV Oj* f ;\ Permit # �; �!1��;s Y / N '�f of G� GYy Will there be any new construction or renovations. MwW4af(4 If so, obtain the proper Permit. Permit # �C� Vv �. Zoning to comDlete the following: Reviewer to complete the following: Square footage of Use 16�c,o f" Y/N Permitted as: Under Section: red- Supplementary regulations section: Parking formula: boa I SIR, i i�L�r6 %t }o Required spaces: aGfl IC2665 G C6 ; N ems to be verified in the field: Inspector : Date: Notes: ate' Viol '�ns: If /N,-1✓i Ifs , st: f Proff rN If If so, ist: V ar��i%% If sost: 's' Rf so, ist. Clearances: SDP's n 7, —a .� Revised 1/1/2011 Page 3 of 3 !tvztt*--� � SECoN� Ff��� y 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, � C J v6 �/ �? v j� [County application name and number] P was rovided to U � �h a M the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number -79 A by delivering a copy of the application in the mann er identified below: /Hand deliverin 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 [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 snown on the current real estate tax assessment books or current-real estate tax assessment records satisfies this requirement]. Si ature of Applicant Mn(sZ Print App icant Name /;:� �,-20 Date 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, � L v O jt � 6 q [County application name and number] was P rovided to lid V v �-h a the owner of record of Tax Map [name(s) of the. record owners of the parcel] and Parcel Number --79 " 1� a by delivering a copy of the application in the manner identified below: v /H and delivering a copy of the application to / 0 [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 IQ — Da- te 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 Date to the following address: [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]. Si attire of Applicant ) (SZ � Print Applicant Name la ^���i� Date