HomeMy WebLinkAboutCLE201200202 Legacy Document 2012-09-25Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff: «J
PARCEL INFORMATION
C )e
Tax Map and Parcel: e) 6,1 ey -- ob — Cf5 --1 7 9 v4to Existing Zoning
Parcel Owner: { _ . �il�r� � `1 L 1 1 /�tiS�'i�%u- r ,q Di. i�Z
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Parcel Address: 13 � o z P, -, � Y, City C` (Ti�i �(�u State j/A Zip
(include suite or floor)
PRIMARY CONTACT r
Who should we call/write concerning this project? Ate' % -- , c1
Address: �i� :� .(✓L- T�,+y City �6 LCz�IT"r�y. ;ue State 1� Zip 2
Office Phone: t 1/ Zg I77Z d'�( CeII # ` 5C& Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name t/ New business
/'�
Business Name /Type: (7 NIA-� Au�,&771
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: 6 PU-,%2f1" VE_H rCt_,
W'03� 15' PNi�,'6 sP�s
*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 reItobest i
I hereby certify thar have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate of my knowledge. I hav read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
,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, 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 i.5(. i
Zoning Official Date /ZZo /�/
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
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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/
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 or ub 'c
If private well, provide Heal epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Reviewer to complete the following:
Square footage of Use: � t
i$ /N ��
Permitted as: �1'�1 L,,' (A !� 21
Under Section: � F /2Y9 — 3y
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Circle the one that appli Items to be verified in the field:
Is parcel on septic or ublic sew
)/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Violations:
Y/-0
If so, List:
/Proffers:'
b/N
If so, List:
Variance:
Y/
If so, ist:
P's:
/N
f so, List:
Clearances:
SDP's
Revised 7 /1/2011 Page 3 of 3
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OPAWINGGPfl0VI0E00Y:
Agent's Design Service GARY ALBERT
112 Easl Washington Str
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CHARLOTTESVILLE, VA
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CHARLOTTESVILLE, VA
Bloomington, IL 61701.1001
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CHARLOTTESVILLE, VA
Bloomington, IL 61701.1001
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 Atx-c- Z, oi w Evyz wxx M the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number f(„loo CX) ° U0 r 17'IAO by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to L.J W AQ J2 I ZEE
[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 4- 1 �3- , 12
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 estat� tax assessment records satisfies
this requirement]. I
of
rrmt Appacant ivame
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Date