HomeMy WebLinkAboutCLE201200138 Legacy Document 2012-07-31Application for Zoning Clearance
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CLE 9. 2 -13�
OFFICE USE ONLY
Check # 19,f> ir)2 Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # �)(7? fir) Staff:
PARCEL INFORMATION
Tax Map and Parcel: ONSBI - Q,5 oA-01LIDO Existing Zoning 14ioL%% ,ay Ccrvwme_rc.ial
Parcel Owner: 69,71 gAN, ( 1 G
(o++ &14 J It State V/ Zip 72501
Parcel Address: -2-165 Se-w iNole.'Vic+i 1 City rla,r %
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? IMo Vo, G aNd ler, I c e 2�-i
Address : 15 C odl S•IverA- S +e.. Zoo City State 6-A zip3 /1-/D/
Office Phone: °I( 12- &Zoi - 51$j- Cell # AiIA Fax # 96(,-3!&- (,q57-E-mail., Ma"/`t e c6aiti d l r -(•i -� r'e!Y/
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ew business
Business Name /Type � In � of ra;n�ie. �j.�c Z/ImFor Ve -6;e- e -r,, kle LeAa Dc� - Secur�� 6� yck.- to
Previous Business on this site 1l' &21 !"r SP&A e_ , $SO SS -C#
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: 6.6frce + e- eS oN f -Four
mom - itpo.� 4:c)D 4w►.1 -?':uw rxM j S,;- 6,rd_s lo- y,C(cx%&b n,-3 Su,)da 4�rkLk, gpccgc
*T is 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 %%� � 4— Printed Mays- C',6"die r
AP OVAL INFORMATION
[ J�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
Zoning Official 1111ai Date
a
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
x,/,;z'
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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 appli s
Is parcel on private well or blic w er?
If private well, provide Health partment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or ublic 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 following:
Reviewer to complete the following:
Square footage of Use: 115-0
y' /N
Permitted as: �i i, C' niOsAs 0-V-- I Q'
Under Section: 2
Supplementary regulations section:
Parking formula:
2J J
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
(�)/N
If so, List:
Proffers:
Y/(D
If so, List:
Variance:
Y /
If so, ist:
SP's:
& / N
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, A 1 b erm a r l e. c��� -4�►
[County application name and number]
was provided to S RI R A N L LC the owner of record of Tax Map
[name(s) of the r ce ord owners of the parcel]
and Parcel Number 0LJS/,S .- oS -oA- of yc�c> 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 1 Rw, ar— 7_ /GS
[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 & /jgl /Z 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].
i I i i s 71%
Signature of Applicant
Print Applicant Name
( I;,m Z
Date