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Home My WebLink AboutCLE201200128 Legacy Document 2012-10-26Application for Zoninii Clearance ��'f2 CLE # 26 12. - 1 Z '- z� ��1iG1��P PLEASE REVIEW ALL 3 SHEETS OFFICE USE NLY Check # ' 2-4426 Date: (o-9,12 Receipt # Staff: Y`n PARCELZNFORMA_TION - -- -- ---- - - - - -- - ---- - - - - -- - - - - - - -- - -- Tax Map and Parcel: f)(()) MO 00 12 OO LC 2. -Existing Zoning Parcel Owner:. Fe-A& ai eaj� -y Parcel Address: '00 )DeY'S QrQ ^^ QA CityC�aY 4 e&V i State VA Zip W01 (inc de suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Mm'a Giljiins Address: rop S. liyey, U1 SU;4 4nU City 1)ra�s Plaines State IL Zip W21 Office Phone: 81 2 Cell # WA Fax # V -Z1 DO E -mail 1 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business '(" Business Narrie /Type: () a soY1'5 Le` { 18ee.j.xArm 1 Previous Business on this site Rwzzit5/ Bfthlkran—t Describe the proposed business including use, number of employees, number of shifts, av{ ilable parking spaces, number of vehicles, and any additional information that you can rovide: s� � j5 p1 TaUrB -1l t tul (( m�e [ ? . 6:111-A r YAP fare S& Kr Aay i S6 i i *This Clearance will dnly be v id 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 may knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Dom. c;;y'0^A�y�^�' Printed Dam (;I cut, ms 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: l22- ' Building Officia Date c____ Zoning Official Date 51/21/ Other Official �� Date % as 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 / N Square footage of Use: 5 7 O 1- L Is usL�in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. O/ N Permitted as: rV Y - / -N- - -- -- - ill there be food preparation? Under Section: If so, give applicant a Health Department form. Zoning review can not begin un it we rece ve approval from Health Supplementary regulations section: !� Dept. FAX DATE (Q� 1a Circle the one that applies Parking formula: Is parcel on private well o ublic water? If private well, provide Hea partment form. - - Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Circle the one that app Is parcel on septic o public sewer? 4 Y/N ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. ^ Permit # permit. A l {�% k Yf/ N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # o 7,nninu to emmnlete the fnllnwinu: Y J/ N ems to be ve 'fied in the field: FL Zr Sa)ja_6L Inspector: Notes: Date: Vio io s: Y N Ifs List: Proffers: Y/N If so, List: Var' ce: Y/� If so, ist: SP's: Y/N If so, List: Clearances: SDP's Q 8/3 J 120 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, ey m1 20l [County applicatio name and number] - - - - - -- - was provided to era I -- RTC - -- - - -- -- - - -- - - - the owner of record -of- -Tax Map- - - -- - - - - [name(s) of the record oANmers of the parcel] and Parcel Number 00 12 DO `CZ 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 Mailing a copy of the application to "e e a l ' 6a_YT"3 i e [Name of the record Aner 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 [Tune 7, 2Dn to the following address: Date 0,e47 eoneert' , '�o�Ky i ale �M� 2C5Z [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 -0& ha C-7 i jjhs Print Applicant Name v UN- Date - 01 % fq� ANN 9 ff M M LY e Application for ZonIn ' CI CLE4 20 17- (2X IAN PLEASE REVIEW ALL 3 SHEETS OFFICE USETNLY C Date, (0 Receipt Q5= Staff.. MIT, PARCEL INFORMATION Tax Mop and Porcel:val MD 00 12 00 ICI Existing Zoning Parcel Owner :. FeAeval Re;41 Parcel Add ress: 0 /1 2 —M-860 XM Oaw Uvrt Ql(yC6Y(A4e&ViRe State VA' Zip m Olive suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Dam 07i4b'5 Address: city nn� P)aifle6 State IL zip bolt Office Phone: 8q1) 21b,000 cell# WA— Fax 9 E -mail -1 APPLICANT INFORMATION U Clieck any that apply: _ Change ofoiviiersilip _Change ofuse Change ofname ->( New business Business Nanie/Type: Previous Business on tills site zzj" Reg�AIA. Describe (lie proposed business Including use, number of employees, number of shifts, av liable P kin paces number of velilcle§, and any additto 1111111 ation that you can proylde:'!.-A� "'TaUrAX, T, i( ) ypwvs�pfl no ly ,Amm- am glie 4n rewhirn , nivi ame jo ewpj&re �5 CID to f �ar tE+- j I *This Clearance-will dnly be vhfid 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 certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the inforination 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 T)Q kJ& Printed—jDayo c4icull"s APPROVAL INFORMATION Approved as proposed Approved with conditions Denied Backflow prevention device and/or c=ent test data needed for this site. Contact ACSA, 977-4511, xI 17. No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with (lie existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building OffIcin Date Zoning Official �A- f Date Other Official Date 7- County of Albemarle DepArtniont 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