HomeMy WebLinkAboutCLE201200235 Legacy Document 2012-12-27Application for Zoning Clearance
CLE # 23
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OFFICE USE O L
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PLEASE REVIEW ALL 3 SHEETS
Check# Date:
Staff: ffVK—�i�_
Receipt #
PARCEL INFORMATION AA�� `j( f�
`I-S `1' Zoning PD S C
Tax Map and Parcel: l'� Existing
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Parcel Owner: t U
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Parcel Address: 9 J O )e1 U [�, - - C r City(' [�.LLL[t)A?_S Utl 6tate VA_ Zip.1.14101
(include suite or floor)
PRIMARY CONTACT
Who should we call /write this project?
�c�on�c�erning
Address: 4 ( W �c ` "'`^�,_t� --(, f City Q.� State Zip c�0 Gp
Office Phone: (`J�d) 34-1 B 1�Cell (� Y 1 Fax I�� E -mail ' / j'►4.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: t
Previous Business on this site L--�&w e,,:n A'We_s
Describe the proposed business including use, number of employees, of shifts, available parking sp ce`s', number of
�n_u�m�bMer�
vehicles, and any additional info rmatio that you can provide: +� t`C.iS?. �tiTLlil
L'} Q_�it % �lP ,' S
*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 accur re best of my k w ge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Printed
Signature
APPROVAL INFORMATION
$,I 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 % (1
Zoning Official Date
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 /1`tl'i
Wil ere 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 ublic r?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap*2F
Is parcel on septic or
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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: :y 000
N
Permitted as: I- 1
Under Section: . Z.
r
Supplementary regulations section:
Parking formula: %
N
Required spaces: 4
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
() /N
If so, List:
byrl offers:
N
If so, List:
6�-
6g -5
Variance:
(D/N
If so, List:
oq— q
SP's:
N
so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
COOST
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5
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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.
L—UY�-
I certify that notice of the application, '\% aei -m -,ca-,
[County application name a n
was provided to
[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 SCT �� I
[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
to the following address:
[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
I
Print Applicant Name
Date