HomeMy WebLinkAboutCLE201200231 Legacy Document 2012-12-27Application for Zoning Clearance
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CLE# 2012` 51
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PLEASE REVIEW ALL 3 SHEETS
Check #USIA
Date:
Receipt # Staff: M
PARCEL INFORMATION
Tag Map and Parcel: S(oA 2 —d I - 2 1 A Existing Zoning
Parcel Owner: 4 n J ovri L LC
Parcel Address: 5 �I I rle �� t�o�� e, City CI-0 2CJ" State V14- Zip lzq�3
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address: -] l,7 00 Jc�jl�'s P1 r ce City .8(1 5-toyj State zip 2013
Office Phone: ZDZ Cell # Fax # E-tn� f'v 0(. Gu I ® ao) I . cowl
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: L 1 V, 4!E) i q Se , r-'e-A / .615 S 24 e- !/YI G S<S 2JQ e
Previous Business on this site Y1 11(�-rt 0 _O n
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
!� (•i¢,rc, i
vehicles, and any additional information that you can provide: ►"1 ID�SS ctsL Q� t �� , �Sc� P _
of-0 CS � : F� �S n,� .i e L)'0 f-0 a1,
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*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 to the best I have read the conditions of approval, and I understand them, and that I will abide by them.
-o-ff-;myykknowledge.
Signature Printed - i^yoi , i k0 ✓�
APPROVAL INFORMATION
[ Vj 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 ((r ( L
Zoning Official 1191#1/ Date l 6 �I
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
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/N
Will there 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 p lic water?
If private well, provide Hea nt form.
Zoning review can not begin un ' we receive approval from Health
Dept. FAX DATE
Circle the one that app ' s
Is parcel on septic or ublic sewer9
Y/N
Will you be putting up anew 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:
Reviewer to complete the following:
Square footage of Use: _ I '-Icy
a /N rn-
'tted as: (� .
Under Section: 1� • p� j e p�
Supplementary regulations section:
Parking formula: IIwo n
Required spaces: 1
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
i
Variance:
Y/N
If so, List:
SP's:
Y/N
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 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, lqc- ZO/1 I n C
[County application name and number]
was provided to An ol an - , L L L the owner of record of Tax Map
[name (s) of the record owners of the parcel]
and Parcel. Number S76 A 2 - O I - Z I 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
X Mailing a copy of the application to ��-✓�+ rh y c �C.p {- .7�n o�a�n �' . LL(-
[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 0&0 6'-r 7-012- to the following address:
Date
444 j6LC 0/1 aree+ 2 9S- I S
[address; written notice mailed to the owner af 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
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Print Applicant Name
rC)/1 /Z01z
Date
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