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HomeMy WebLinkAboutCLE201200248 Legacy Document 2012-11-28�ar�;tC(XI 6(,t' Application for Zoning +'llearance .��� �'�� CLE # L+- I ft .�ri \A OFFICE US PLEASE REVIEW ALL 3 SHEETS Checic # Rte: Receipt # Staff: PARCEL INFORMATION J`7 Tax Map and Parcel: 0­7? oo —eye) — Qz -- 4 1-7 D d Existing Zoning Parcel Owner: 6144 -70 S* 9t4c 0Ptnr ' —rep_ Parcel Address: ?9-( e4N -%P,f C-TR City 2tt� ' U LLL State �JA- (include suite or floor) PRIMARY CONTACT p q Who should we call /write concerning this ro 3 ect,��'� f Address : 2Z-Z PdALA& -- (1koct e l City Ctt ` t/+ LLC_ State UTA- ZtpgLot It office Phone: �� -�'V( Cell # Fax # E-mail 8- cW ` t_ ` J4 14 14L 6e v\- A,A -c..ts . CJ APPLICANT INFORMATION Check any that apply. Change of ownership Change of rise Change of name New business Business Name/Type: 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: C° rk 2.-t S'r M 1-1-1 —rgt' - 13 L.&4 *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 accurate tqAhe best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature u.�C PrintedAt; X27 W dl t -t> f APPROVAL INFORMATION Approved as.proposed j j 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. [ j This site complies with the site plan as of this date. Dotes: Building Official - Date �� ✓/ Zoning Official Date .� ` Other Official .t t �' Date county oS AiDemarit meparemeni ut %,umittucttiy 401 McIntire Road Charlottesville,'ijA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 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 th re 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 o ub ' Witt ? If private well, provide He ment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that Z,,r les Is parcel on septic ubliap . 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 # Reviewer to complete the following: Square footage of Use: %/N Permitted as: � �n�/i�� /c4 Under Section: -4 Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: &/N If so, List: f Proffers: /N if so, List: 0 Variance: Y /No If so, List: SP's: l Y If so, 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 0ecarpation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits,l3uilding Permits) if'the application is not the owner. I certify that notice of the application, [County application name and number] was provided toy N °�' S S, 4vP/ i�rq C�7V 'c �� Ll C the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number . U -7 M — cM — Utz C' 1 -7 0 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 1/ Mailing a copy of the application to L��v rt cry �, Ir C [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] to the following address: Date � Q � lX SS Zin Crt A, 2 i_o'T7&1 v LLt-- l/la- [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]. &U ,W Signature of Applicant Print Applicant Name Date f.-:) 6) - � m �j Sc.-CL,t -.7 -e 67, S '1(6_ �J m CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVI]DE]D 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 �� N Tot' S S,�ar°/ �^�9 CL,-N7 &7,, , Ll C the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 0'7 S TO — c1-0 — W — 01 -7 D 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 Mailing a copy of the application to (P- -, -TGn t ''V I Coe'l "rte L L- C [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 Apf (L"A-` 6 i C " -`y to the following address: Date ea 8 d)( 5 SZ6 Cct �z i_v ^7ES dr i/i�, 2 z %a [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 T.. wNC-U-�,�J Print Applicant Name i (—(JP— &)tZ Date