HomeMy WebLinkAboutCLE201200111 Legacy Document 2012-07-13Application for Zoning Clearance
CLE# 'ZO)Z
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PLEASE REVIEW ALL 3 SHEETS
OFFICE S LY Q
Check # Date:
Receipt #w Staff:
PARCEL INFORMATION
Existing Zoning (�
Tax Map and Parcel: -� {C�
LIV
Parcel Owner: Lery GrgswJ
Parcel Address: 1 L� g2L fectiinPTeT PL city ('6r[o rd(t State 1/ Zip bl'
(include suite or floor)
PRIMARY CONTACT t
Who should we call /write concerning this project? r A j [Aaw�
Address: t q ,)HC vleeh ,yrri c/ PL City CLr(rliA4ts,j State f/A- Zip 9X0
Office Phone: L -QLIt O Cell kW8; •7S�ax# czRa 65Chop,,afG(f�
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
_Change
Business Name /Type: 4 1aS r, d'r, , L L c
r Is o-wEb 5ervr
(ji
Previous Business on this site � �t c,3 a, / rG Q r k rJ, C w % �k 1tic /'�Q�1^ ,` v\ �c�c e, %�✓� ew. e Fir= AO �,
Cl.,vz.,� ra c{ pYS
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 rovide: ` U)t_b �� 'I "�:C^ ctev 5 % dle�
tNS i C) O -r�Ci aCes Ur2,NrcL 3 'S C n l a
r Mw' G rn I ed er *=- C_daox ^ -e
*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 1 cation, 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 kno d e. hav read the conditions of approval, and I understand them, and that I will abide by them.
fl 'I
Signature Printed C r,C� : c 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, 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 Date f
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
iKl
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 pu is wa ?
If private well, provide Hea partmnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that pplies
Is parcel on septic or u lic sewer
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to com lete the followin :
Reviewer to complete the following:
Square footage of Use:
(�/N
Permitted as: L „-; ,-r 4 c d 1 1
Under Section:
Supplementary regulations section:
Parking formula:',]
U
Required spaces;
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violat• ns:
Y /
If so, List:
Pro Mrs:
Y /
If so, ist:
Variance:
Y /
If so, ist:
SP's:
Y /
If so, List:
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 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 - I y- r 4 rC, f -e-A o f Li the owner of record of Tax Map
[name(s) 6f the reco4 owne 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 L&(, (,'1
[Name o the recor�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
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].
ignature of Applicant
C�j 0;c �, i-� L
Print Applicant Name
Date