HomeMy WebLinkAboutCLE201200164 Legacy Document 2012-08-07Application for Zonin Clearance
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PLEASE REVIEW ALL3SHEETS
Check# Date:
Receipt # Staff: ry'IAW,
PARCEL INFORMATION
Tax Map and Parcel: (,01-27 Existing Zoning CC
Parcel Owner: Carr \Jfooc( lI- cocEuclS LLG
Parcel Address: 233 HuetrcuAvc- ►'c( e P City C_�arlo4cSvilik State yA Zip 22go1
(inclufle suite or floor)
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PRIMARY CONTACT
Who should we call /write concerning this project? i Saw i6LA.1 e-
03
Address : 33 vclra. ,&tic.2 cige_ Q4 .StAi ye City G�a,1a,4Aesllrlle. State �JA Zip 229o1
Office Phone: (13 ) 260 -o7N9 Cell # Fax # E-mail cats
mail. COK
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: L7inge oY I'L i)Q+Ckr\)'Ca1S, LL C_ , LALt vrf +ion consul 1.0 �1 am S
Previous Business on this site n a S }in -r a �hc, li , L
Describe the proposed business including use, numbe of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: 1 fn a a wi e i n
o i C e.. No e )c ct a.\ a loin a< 10 ,acev, .
rove in r' in*C# I I&J COVI o s wr kin o
C act.
*This Clear ace 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�i r�dSQv%g
QJ
APPROVAL IN MATI N
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 Date
Other Official Date
county of Aloemarie uepartment OT t;ommunity Uevelopment
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 /N
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will ere 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 OiQu li ter?
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 app ies
Is parcel on septic or ub er?
Y /O
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit#
Y/0
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: 10 J
O/N �,
Permitted as: 6-P (_,z,
Under Section: 23-1-1
Supplementary regulations section:
Parking formula: /�J
1G e
Required spaces: All
Y/N /
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/0)
If so, ist:
NIN offers:
If so, List:
a -73-2–d`/
Vari nce:
Y/'
If so, ist:
SP's:
6>/ N
If so, List:
65,-Z-/
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 accompanyzoning 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 (�Grr % oocl i o&%Ae-AS Lt-(- the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number (Q I - 2:7 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 r ar r W QQ ct 0 &� c4S LLG
[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 —�-w 25) , 2019 to the following address:
Date u
5 oz Will
[address; written j
the current real es
this requirement].
A 2yyo
;e r6ailed to the owner at the last known address of the owner as shown on
tax assessment books or current real estate tax assessment records satisfies
Signature of A plican
i ndsay 41u q f-
Print Appli ant Na e
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