HomeMy WebLinkAboutCLE201200244 Legacy Document 2012-12-13Application for Zonin nClearance
CLE fit' •
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PLEASE REVIEW ALL 3 SHEETS
OFFICE U E O Y Date: i� 12-
+;C,heck # lU
Receipt# Staff: _E%0 J/
PARCEL INFORMA (% IO /�
Tax Map and Parcel: o ej 461 f A 0- 00- Q- 01Da3Existing Zoning
Parcel Owner:
Parcel Address: i 12kf2 Sv e dd� city C1�(��s�%� ale State `% A Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 1% ��'�N (C) C �� 2�N i�JC'n�� +Qa�� Y L l
Address : %5_,�.3 MoI06-& —&127 /2,J5&- 12A City Ckcy2 State \_JA Zip\g
Office Phone: ( �Kk - — Cell # �_1(- )N4 -& Y5(F.ax # EU -60 f-1'71 ')E-mail (0 Ck YZ&l Q yc, �vo
APPLICANT INFORMATION
Check any that apply: Change of ownership L,_: Change of use Change of name X New business
Business Name /Type: A y ,_*yye, tl2Mj
1�v'r� uU `1,. Co v-;PConY (t� Q � /z2 o, Q � -Vd 0��J)
Previous Business on this site � 5
Describe the proposed business including use, number of employees number of shifts, available arking spaces, number of
�•AM -'s AM 1-, i .
vehicles, and any additional information that you can provide: NU . U.)�,2 -bt .
�20
' M P "-1 ;.2CNS 2k 'lU
SOra - ye�i c(ef
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*This Clearance will only 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 'I if 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 curate to the -be`st of my edge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature i Printed M � ,�
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APPROVAL INFORMATION
JK 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 f
l
Zoning Official / Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902-Voice: (434) 29.6 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y/,CTN�)
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Wil ere be food preparation?
If so, give applicant a Health Department form. ° t
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well ublic water.)
If private well, provide 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 septic o public sewer.
Y/C
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/®
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: '"�D
!M
Permitted as: is s;n,T.sT4jt�
Under Section: ZSo', 2 : J
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Zoning to comDlete the followinLY: '
Date:
Violations:
Y /(N—
If so, List:
Proff rs:
Y.y
If so, ist:
Varia. ce:
Y /(f
If so, List:
SP's:
Y4
If so, List:
Clearances:
SDP's
J 1,
l Revised 7/1/2011 Page 3 of 3
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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 - &_W QV-" G 0 7, LL-6- (ke-7 &i I the owner of record of Tax Map
[name(s) of the record owners of the, ,parcel]
and Parcel Number 06 1 fA D (x*Q- a 61- -. by delivering a copy of the application in the
in identified identified below: `
delivering a co of the application to ti � 4 D. fi LIL- ' C t" �� I�
copy rr R n S S �,
[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 1k1\, (( \o,
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
�IS �ep,_[
[address; written notice mailed
the current real estate tax asses:
this requirement].
to the following address:
)4qo
r1he owner at the last known address of the owner as shown on
nent'books?or current real estate tax assessment records satisfies
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SignatGre 6TApplicant
fl� ken�e
Print Applicant Name
Date