HomeMy WebLinkAboutCLE201200149 Legacy Document 2012-10-24A lm�
WA
Application for Zonin Clearance
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CLE1
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 17M Date:
Receipt # 3 Staff: nN1C ,
PARCEL INFORMATION
Tax Map and Parcel•rz'�'y((� T �rj Existing Zoning
Parcel Owner;
Parcel Address :! r/v�k i�G('l' Id /0 City, 8 A' State VA Zlp A` -9
(include suite or floor)
PRIMARY CONTACT �,
�MA
Who should we call /write concerning this project? aM
Address, r �• �b _ Clfy &mllj, State V ZIP 2d 3A
r
Office Phone; L—) Celt # �aS =6913 Fax # Email S�1 , t? t� a t°sY►4*?�3 i t
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use of name o New business
f___Change
%
&j6dS & do
Business Naneflype Choss ink, k 0,- wk; f ✓DQ�/ T p�Y kri Ci`
Business i) O
Previous on this site a.0
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, Opp any additional in r atton that y can provide:
i i S
*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 new Zoning
Clearance will be required.
I hereby certi at I own r ha a le r permission to use the space indicated on this application. I also certify that the information provided
is true and urate to the low dge, I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Tali -IP.
APPROV RMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Baciflow 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 Of#icial Date
Other Official a Date [ 06U i 1 a
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
Intake to complete the following: Reviewer to complete the following:
Y / D Dc Square footage of Use: 1,//
/
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. / N
Oermittedas: 2 ' AkliJsms
Will N
ill there be food preparation? Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well publie�tSr?
If private well, provide H Ith°H iftment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies -
Is parcel on septic or ublic sewer.
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin to complete the following:
Parking formula:
�ativ
Required spaces:
Y /O
Items to be verified in the field:
Inspector : Date:
Notes:
Vio ons:
Y/
If so,, ist:
Proffers:
Y/
If so, ist:
Varian e:
Y /
If so, List:
SP's:
�b/N
If so, List: Zj
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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1 of 1 6/29/2012 1:44 PM
CERTIFICATION THAT NOTICE OF TBE
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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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 -1ho d O Q (b A - - 2r-",
[Name of th8 record owner if the reco d owner ia 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 %/ q / to the following address:
Date
-P,0 i3* 1 Zq , eeb!ge, �A 2293
[address; written notice mailedjb 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].
1Z
Date