HomeMy WebLinkAboutCLE201200027 Legacy Document 2012-07-16Application for Zoning Clearance
CLE # i DI 9
0
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date: � ` ffo- „Z
Receipt # Staff:
PARCEL INFO T
Tax Map and Parcel- lJ' I � U Existing Zoning,
Parcel Owner: �r�
Lo L q
Parcel Address: �I t� i1 Cih 1� it l State �i �i Zip t
(include su to or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? _.M ED PX eg f S's
Address: !75 9 EARL CORE (Z0A 0 City H0 &.rte j-ay14 State \&/V Zip'Q6 p
Office Phone: Cell #304 �2,gi-6o%Fax # E -mail EOIET -7 0— HF-0 RPM S • C
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _New business
Business Name /Type: ME O rXPRES s u GF- N T r-ARE, Z USE
Previous Business on this site MaRgls tlI/ I- AN'nIQLA1r S A0 CoQST(,N HE T—
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: 1 1') C`6 O 5 SAL_(, � W C L l W T C'
LOSE e .:1 8 f S PAC E5
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed E R1 C. 01 E'7-
APPICOVAL INFORMA ON
[vf Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] BacIdlow 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 detennination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes
Building Official Date m_/
L
_/Zoning Official Date 7
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
UK
.'Z
Intake to complete the following:
Y )CN)
Is use un LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will h re 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 we ublic_wateO
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic r public sewer?
3'/ / N
gill you be putting up a new sign of any kind? If so, obtain proper
Sign permit. /
Permit # m st ,, mv-d
V� N
Till there be an y new construction or renovations?
If so, obt ' e er-P t W
Permit # -� 1 b5(�{� (ID la
Reviewer to complete the following:
Square footage of Use: 5-,5 3 a
6�/N ) rr
Pennitted as: M eA,'( 4/
Under Section: ZS. 2.
Supplementary regulations section:
Parking formula: 211 ice
fpSC/
Required spaces:
Y / %1
Items to be verified in the field:
Inspector
Notes:
Date:
uvuua Ei !LIE
Violations:
Y /N&
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/
If so, ist:
SR 's:
/N
f 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 accompahy zoning applications (Flonte 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, (. o b 2 - 00 1373 - A C,
[County application name and number]
was provided toH(A[� I 9.1VEffC�Fd.1'°f C
,OH f AN Y the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 07aQQ- QQ- 00- 09 ?'U Co 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 Mailing a copy of the application to (DR C #ARLES \AJ. IJUl(Z
[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 �� ) RU, A &Y 3 "° 4 � O 12.to the following address:
Date
[address; written notice mailed to the owner at the last blown 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 Apphc
ER-. C, OXET -Z
Print Applicant Name
Date