HomeMy WebLinkAboutCLE201200123 Legacy Document 2012-07-12Applicati ®n f ®r Zoning Clearance
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CLE #
OFFICE y
PLEASE REVIEW ALL 3 SHEETS
Check# Date:
Receipt # Staff:
PARCEL INFORMATION n
Map Parcel: 06 Q Existing Zoning
Tax and C7 - C20 U G c9 0-0
Parcel Owner: ?anc9% L % `J g &A t
'L
Parcel Address: G "ar6, � I CJ ity 6arL-�,,' State V Zip 11
(include suite or floor) /y rywr
PRIMARY CONTACT - - - - - - - - - -
Who should we call /write concerning this project? j O S k ail r� 6,
Address : gsrs- U a t" rti �� city_( V t ([C State , J Zip
Office Phone:A 4 A24 • 14 3 Cell #135 12,"t Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownerships. Change of use Change of name New business
f
Business Name/Type: C u M l/1/� e f C i a l P(bgs-rIt'05, 46 lee, I 1 S T .. (i) .
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Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available kin aces, number of
vehicles, and any additional information that you ca erovide: ,m%t4A ; f /Va [ f S o
4 A '/ Vte
*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 kn 8 wledge. J have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed I ;" (JSCj
qAPPROVAL 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 G �S -T—
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:
Y/KIs us in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /A
Wih4Kere 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 wel or public ter?
If private well, provide ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app ies
Is parcel on septic or rc 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 #
Zoning to complete the followinLy:
Reviewer to complete thee following:
Square footage of Use: D
�l N �j (�
Permitted as: &61 A, ,� O -M QC,
Under Section: - --5 X4.2
Supplementary regulations section:
Parking formula:
4s
Required spaces:
Y
IterWto be verified in the field:
Inspector • Date:
Notes:
Violations:
Y //I!
If so, ist:
Prof ers:
Y /
Ifs st:
Variance:
Y /(NJ
If so, ist:
SP's•
Y /D
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
A) 3922ft- 1 1/2 ST. OFFICE BLDG
B) 174ft' POB
Q 1512ftz GARAGE
built 1980
http://gisweb.albemarle.org/GISWeb/Showlmage.ashx?t=k&f=SOOOOI 16 \50007708
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Hoyle 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, A,E c C 4 P 1 I
[County application name Ad number
was provided to 5e/1 , i% r 1 &,J LL -- the owner of record of Tax Map
[name(s) of the record o iers of the parcel]
and Parcel Number ` Z) 6 a GU by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to ,> (A $ 4 ^ l (U t t,`
[Naive 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 S
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 shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
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Sio&kug of Applicant 22
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Print Ap licant Name
S / ?1 1/1
Date