HomeMy WebLinkAboutCLE201100213 Review Comments Zoning Clearance 2012-01-03Application for Z nin Clearance
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PLEASE REVIEW ALL 3 SHEETS
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Checlz # Date: •. 1
Receipt # Staff:
PARCEL INFORMATION _
Tax Map and Parcel: &/.'l'r�G— Existing Zonin - IC1 p,{"
Parcel Owner: t" 4199 l- l I(�
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Parcel Address: a 500,5zo 5go 1570 City S >!�GV �k?`�,ui11� State y Pr Zip
(include suite or flour)
PRIMARY CONTACT �] �7
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Who should we call/write concerning this project? f 1� C VO fZ 1 0 rAVQ
X. 113city Ojp.t State rA C) zip Z0(_0I
Address: & I I Z j p/,_i_ _ -
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OfCce Phone: ?D b'�o3,) 0z Cell t� % rax 513' - b e-mail t�� �� 21yi . l yrn
APPLICANT INFORMATION
Check any that apply: ' Change of ownership Change of use Change of name New business
Business Name/Type: p F)\.N Al ( ld��? Pans
Previous Business on this site ,�b&4jq 15tilVY 2 VAcAX bA /A IV
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: 6 IAIQ PolAS 6$ „, tnea ran'4-i I
*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 now 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 a to 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 AI' IJ ' ���
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
<- Approved
[ prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] No physical site inspection has been done far 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:
�. Date
Building Official
Zoning Official ° Date
Other Official Date
County OI Albemarle llepar[ment oI uummunuy veraiup l AVIAL
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 u n LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Will�lfere be food re aration?
p p
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 applireltph Is parcel on private we l' lic ]artinent a er ?
If private well, provide I 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 ,pu, lrex.;
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # :Z,sl/ —'/ 9,V
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 9 yo- f 7 -10
ZoninjZ to complete the following:
Reviewer to complete the following:
Square footage of Use:
P / it
ermitted as:
i
Under Section: � 7'1,'2 -
T ,
Supplementary regulations section:
Parking formula:
P b,5
Required spaces:
Y/
Item o be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y /(D
If so, List:
Proffers:
(j/ N
If so, List:
Var' nce:
Y /l
If so, ist:
SP's:
0/N
If so, List:
>51-1
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 ueust accompany zoning applications (home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
otVner.
I certify that notice of the application, 1�rh I t ems,. it) rj u' t- ' Aq d cc-trc t e
[C my application nam d num er]
was provided to rd o,, OJ Q 20 the owner of record of Tax Map
[name(s) of the recor wners of the parcel]
and Parcel Number 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
_X_ mt
� a copy of the application to m T
[Name of1the 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 2! /1 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].
Print Applicant Name
12-)2-
Date