HomeMy WebLinkAboutCLE201200161 Legacy Document 2012-08-070
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Application for Zoning Clearance
CLE # 2012 - I to 1
PLEASE REVIEW ALL 3 SHEETS -
OFFICE USE ONLY
Check# 1 Date:
Receipt # Staff. � (�
PARCEL INFORMATION N
Tax Map and Parcel: 45 %r Existing Zoning D5C,
Parcel Owner: Ac-_W SCSI R/Q 44ILL U_t✓
Parcel Address: P-741 R%® H/U— (_'C/( City %VLD1% VILLL' State d Zip22 1v
(include suite or floor)
PRIMARY CONTACT -
Who should we call /write concerning this project? _�VC -, 5_ 7'1_ANSFA1, e IV' " i5_41 L% &
Address: 1:�-�24 &' 1L 011MW eal) City,44 State 7A_1 Zip _3709Z1_
Office Phone: �j( /8) M Cell # Fax 44 .096�?Vj_ E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: V %,e1A1� -; Y � /��0��� -� l7/,► ,�?(/ ` %ry�
Previous Business on this site
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:
ze"
*This Clearance will only be val d 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 4WAW 2"1016,4111
APPROVA ' INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] i3ackflow 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
Zoning Official LAIII 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
41,
M
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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 /1'tl
Wil sere 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 o u jc w
If private well, provide Hea ailment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap es
Is parcel on septic or public sew r.
Y
Wil ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will sere 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: 400 �cc
1
N
Permitted as: i°'�'� I
Under Section.. S. 2
Supplementary regulations section:
Parking formula.
�
JS�,
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
& N
If so, List: � %�
Prof! s:
Y/
If so, List:
Y-zC)
D�
Variance:
v/N
If so, List:
P's:
IN
If so, List:
Clearances:
SDP's
2a�2 3
Revised 7/1/2011 Page 3 of 3
a � i
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form mast accompany zoning applications (Home Occaapation, 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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number 11-6 I4 by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to A J�V) GC 1 RI() O j u � LLC-
[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]
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].
Signature of Applicant
Print Applicant Name
Date