HomeMy WebLinkAboutCLE201200170 Legacy Document 2012-08-10Application for Zoning Clearance
ov n� �u,
�i;µ'`-
12 — I%
...,k s
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE 9�V�
Check # 16 Date: �J
Receipt # Staff:
PARCEL INFORMATION //
Tax Map and Parcel: 1),115'00_00-00-1017C f'� 771 ` ,,T5 Existing Zoning C ✓/11/NC�C /��
Parcel Owner: 141000,6400k a: 50C/F4 7E5, U—C—
Parcel Address: 901q W00.600k C_� City V1465:State Zip zz of
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? /�'I �/
I JCL Ljq-tJ50AJ
Address : vw /9 Woob6e -O-OK Cr City C_W4L-0R;251(1/L ,9tate V14 Zip ald
Office Phone: L_) Cell #rV®h1 +o �%�(Fax # E -mail 7V / 616+,,eA_j0
62L57"amA1(5& C,2c1177,&pL 4f6r
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
_�
Business Name /Type: ( �57?1 W!`6 C.g- ''%%0A ZJ—C
Previous Business on this site /q-7M "C- ,V5
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: — S > 6
mZ— 3 ���'Hi LLC-5 !2.4,4 l �— ,5,Pm i�-.Di &LIX _OT A_74 J6r SPi9�'�5
*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 accur to o the best of wl e ge. have read the conditions of approval, and I understand them, and that I will abide by them.
hkKn
Signature Printed ri GRAk.L. �. �d'11���
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow 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 " t0 — l
Zoning Official Date_ /D/
Other Official Date
County of Albemarle Department of Community Levelopment
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? 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 applies
Is parcel on private well or lie Ovate ?
If private well, provide Healt Depart nt form.
Zoning review can not begin unti we receive approval fiom Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or p s er?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoninfl, to com lete the following:
Reviewer to complete /t�hle following:
Square footage of Use: / /
? / N on
ermittedas: �( (.J�{C.
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y / Ir1
Iterhefo be verified in the field:
Inspector:
Notes:
Date:
Violations:
(Y / N
If so, List:
A i' IS
Proff rs:
Y /
If so, ist:
Vari nce:
Y/
If so, ist:
SP's:
Y/
If sb' 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,
[County application name and number]
was provided to W006"Cll- F `-L C-- the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number -ZR ' oYJ'PQ-Od OOO -10TC.0 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
r✓ Mailing a copy of the a pp lication to �Ibo P4kooK :5,50C- h*7;S5 c-1 Aecc557 60?a7A25
[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 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].
Sig, Ature of Applicant
/�°r c' , ziW - �, L AW50119
Print Applicant Name
d/ -Jacy 2014
Date
I