HomeMy WebLinkAboutCLE201200139 Legacy Document 2012-07-12A pp lication for Zoning Clearance
CLE # 261 G- 13
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OFFICE USF Q�1LY f ^ `�� ' z
L} (phi- Date:
PLEASE REVIEW ALL 3 SHEETS
Check # lV
Receipt # Staff: r \
PARCEL INFORMATION
Tax Map and Parcel:: b SS 610 — 0 ^ O O DO 0 C O Existing Zoning MAO Ah tI 14ex,*d� �[
AoLrCk 40AJC Av-,ie s LL G
Parcel Owner: lk
Parcel Address: /' D, &ox 370 City Cry Zt%( State L/4 Zip
(include suite or floor)
PRIMARY CONTACT f
Who should we call /write concerning this project?
Address • too S f `er. ` e &4 City C 111 ti State vA zip 2,413 •
+E I t>
Office Phone: � Cell # Fax # E- mail(,t/t'1 %rsngp/ Zt/• cr
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: s. t� hAjesiole,41 /kRK4 IZIert
Previous Business on this site
Describe the proposed business including use, number of employe s nu ber of hifts vailabl parkin spaces, nu ber of
o. W
vehicles, and any add' tional info r ation t at yo can provi uJ
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*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 tot best of 'k_nowl /edge. I have read the conditions of approval, and I understand them, and that I will abide by them.
YAO*L
Printed I J�frr-!f
Signature
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Coptact ACSA, 977 -4511, ;117.
[ ] 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 tA 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
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Intake to complete the following:
Y 161
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will there 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 ubli ater?
If private well, provide Healt Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a pli-s-- ----
Is parcel on septic r public se r?
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of User
N
rmitted as: 0�'-
Under Section: ���,Q�1 L) l l C• -1!
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
O�o, N
List: A
Proffers:
/N
If so, List:
Pare ce:
Y/(
If so, List:
SP's•
Y/
If s , est:
Clearances:
SDP's
20
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,
(. I I ((JtfkA(4rj [County appplication name and number]
was provided to 6W N/� l S6 n C-4Afol,d +J the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number OS Sep - O 1-00- 400 Cv 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
[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 p
--- f dhA�I d a
[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
y` -otry Ro" ci
Print Applicant Name
6 -(N -c7/
Date
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FLOOR PLAN
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OLD TRAIL
ALBEMARLE COUNTY , VIRGINIA
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