HomeMy WebLinkAboutCLE201200127 Legacy Document 2012-08-07Application for Zonine Clearance
CLE9
OFFICE LJSEi zONNVY -7
PLEASE REVIEW ALL: 3 SHEETS
Check# Date: 10- -12-
Receipt # staff: rv--% 12Z
PARCEL INFORMATION
Tax Map and Pam e 1 0 00 — 0 S'Q 0 Existing Zoning_
Parcel Ownei-:1 L L C.
z:
? ®! -t
Pa reel Address: 1? 7-2. 1777` ,�p u city e—'A Ile- state 1114 ZiDZZY4,z
(include suite of floor)
. . ............. .
PRIMARY CONTACT
who should we call/wote concerning this project'7
Address ::30-cn ?izes4oy ty State 7f zin
Cell# -L-06-JjV6Fax# 12�O E-mai�
Office Phone: i
APPLICANT INFORMATION
(,'Iieckai)vtliat,,ippl3,:_C'li,ingeofownei-shil) _Change ofuse _Chan geofname New business
. . .......... .
W
Business Nanie/Type:
Previous Business on this site Ne. Vj u 1 l d J'SA 0 r Ae'o a 4 r
Describe the proposed business including use, number of employees, number ofshifts, available park . V912S, numl f
"19 1 0
'W/,Nle- NZV
vehicles, and any additional inforfflatiolj�that You c 1), ovide: �+dRATC Q IV 0410
�-" 114 0
'`This Clearance will only be valid on the parcel .for which it is approved. Ifyou change, intensify or move the use to a new location, a now Zoning
(.1carance will be required.
i hereby certify tl at wn or have the m; el>,permission to use the space indicated on this application. I also certify that the information provided
is true 2nd acu a,�lie be f In- k o I iave read the conditions of approval, and I understand th ^ 1,arld that I will abide by them.
vDr.
Sicynature Printed
Am ea
AP ONIA.I.—INFORMATION
[LApp�oved as proposed Approved with conditions Denied
t Backilow prevention device and/or current test data needed for this site. Contact ACSA., 977-4511, x..l 17.
No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ 'I This site corriplies with the site plan as ofthis date.
Notes,—
.... . .... .
Building Official Date
Zoning Official Date
othel. Official Date
County of Allmnat-le Depai-tment of Uonimunity vevelopment
401 Mclutim Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax., (434) 972-4126
Revised 7/1/2011 Page 2 of 3
4 a k"
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Intake to complete the following:
) N
use in 01JIorPDIPzoning? l.f so, give ppl)licaiitaCei-tifie(I
E,'i I Cy incer's I:eport(CBR) packet.
lollitted
Reviewer to complete the following:
Square Footage of Use:
Y N
ri as:
Will I 'e be food preparation?
Under Section:
f Cso, give applicant a Health Department form.
Zoning review can not begin Until we receive approval From Health
Supplementary re-gulations section:
Dept, FAX
Circle the one that applies
Parkinc, forinula:
par(x I oil p irivate well or u blic Watel.?
6e�' A�nl'nt
_ �)W-I-s-
Required spaces:
If private well, provide Fle, th . e arrient form.
Zoning review can not begin in til we receive approval.frorn Health
Dept. FAX DATE .... .............I............
Y
Circle the one that a 'es
Jtenllt�o be verified in the field:
Is p arcel oil septic ?r !puEblicsewe:r'?
,
y i ,
Will2 be putting LIP a new sign of any kind'? If so, obtain proper
SDP's
Sign permit.
Peralit # . .... . . .......... . .......
Inspector Date: . ... . ..........
y /
Notes:
wi,IlQre be ariv now construction or renovations?
Ifso, obtain the Proper Permit.
Pei-Init H
. . . . ...........
Zoning to complete the following:
Violations:
Y / NT
Ifs(), List:
P1 ff
'o
y /
Ifso. tlrst:
Vari e:
Y, "
If so. is t:
s
N
so, List:
ut•, a
tf
SDP's
Mif qq
10, W
M-1 ILA
Revised 7/] /2011 Page 3 of 3
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER.
This form. nrrrst acconrpcnrt,, zoning applications (Home Occupation, Zoning Clearance, Zoning
Aclrnznistratar -I)etet ^initiations- or- Alil)eals, 5'it;n- Aer- neits, l3rrildinh :Pe>erzits�- iJ'the crppliccatiorP-is- not- tJre --
n wr7er.
I certify that notice of the application, 111e4 ! PJ 1 A Wl h eWo tL K,5
[County application name and number]
h,as provided to _X D_P - __ _ _._ _ ._.- the owner -o f' record-of`T'ax Map - - -- -
[name(s) of the record owners of the parcel.)
and Parcel Number C 9060- 00 - ®a- 69.15'6 0 by delivering a copy of the application in the
manner identified below:
✓ Hand delivering a copy of the application to _ P fl L L C-
[Name of the record owner if the record owner is a
person; if the otivner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
o.n W 4
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 A)Applicaut
% S T
Print Applicant Name
o
Date
AU9, It /IM, I i : JZAM
i.
ri
NO. 3994 41 ?
136 /