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HomeMy WebLinkAboutCLE201200036 Legacy Document 2012-07-13Application for Zoning Clearance's CLE # OFFICE U PLEASE REVIEW ALL 3 SHEETS Check # Date: 1 Receipt # Staff: PARCEL INFORMATION�� Tax Map and Parcell:'' 0 -3 ZL70 —DO - oo, 00h 90 Existing Zoning Parcel Owner: �\ A660 C.' 1 Parcel Address: Z r t AY- 000k ,Jr'% 04, City (n �Id �SUi��L State Zip (include suite or floor) PRIMARY CONTACT Who should we call / concerning this project? B FJ 62a-lu /write Address: �S� %J ��U 1?�MJh7 • City 1, 0 State V0� • Zip s Office Phone:(__ Cell # S � i t Fax # E -mail CV *P1. L. gaLo APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business //��n Business Name /Type: Q, M p� p� » ©l/�1 a z---, Previous Business on this site 40A34— Describe the proposed business including use, number of employees, umber o ifts, available parking spaces, nu er f information �� vehicles, d any additional t t you c rovide: •�� ' % r� a C2 is u s �. 4_ / W'as r� EACOL ,Sr *This Clearance will only be valid on the parcel for which it is appro ed. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I ovprgr have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate ie - est of my aiowledge. I have read the conditions of approval, and - Iunderstand the i, and that I will abide by them. Printed D Signature o­rL I APPROVAL 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 Date -Z 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 1/1/2011 Page 2 of 3 Intake to complete the following: Reviewer to complete the following: Y / N Square footage of Use: �U Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. );Y / N rmitted as: Y/N Will there be food preparation? Under Section: If so, give applicant a Health Department form. SP's: Y/N If so, List: Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE Circle the one that applies Parking formula: Is parcel on private well or public water? Clearances: SDP's If private well, provide Health Department form. Zoning review can not begin until we receive approval fiom Health Required spaces: Dept. FAX DATE Y/N Circle the one that applies Items to be verified in the field: Is parcel on septic or public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: Y / N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7,oning to comnlete the followin¢: Violations: Y / If so, List: S offers: / N If so, List: Varian e: Y/NI If so, ist: SP's: Y/N If so, List: Clearances: SDP's Revised 1/1/2011 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must acconipan.), zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or• Appeals, Sign Permits, Building Permits) if the application is Trot the owner. 1 I certify that notice of the application, ,t,' o- ►-uuoo 111nodJ 0 'C-Q- [County applica ion name an number] was provided to �of 2 the owner of record of Tax Map [ �aine((s)) e re co d owners of the p rcel] and Parcel Number 6) ZL70 -00 -d O -0a00 by delivering a copy of the application in the mammer 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] Oil 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 cun•ent•real estate tax assessment records satisfies this requirement]. Signature-of f Applicant Print Applicant Name X1161 ?,- Date