HomeMy WebLinkAboutCLE201200201 Legacy Document 2013-01-04F. �
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Application for Zoning Clearance
CLE # ZO 12 - 201
J •. 4
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE N . '
Check # (Pi Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Ti¢ Y n7,q-P SCI' Fh -&GEL //D Existing Zoning �G
Parcel Owner: C71'e �cL54r_,n ft ,_K AL 4 FO Box 6-5-2-G4 C_h4 r (o #e 5'i le /,Y'+ 2 z 96 ' S'
Parcel Address: 5'fo Rad6wol Zane City Gre,, State Vi4— zip 7-Z93
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Gregg Jones
Address: 3836 Washington Blvd., Ste, 9 City Martinez State GA Zip 30907
Office Phone: (678) 438 -4914 Cell # Fax # E -mail g-jones!aMheborder.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _New° business
Business Name /Type: Pizza Hut Del ivery Carrvout
Previous Business on this site N/A - Vacant Space
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: Pizza delivery carryout unit with a maximum of b
emplo�,_ces per 2 shifts per day in common shopping center.
"'Phis 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
C:Icarance will he required.
1 hereby certily d I owm or • ie o . c"s permission to use the space indicated on this application. 1 also certify that the information provided
is ulte and a rate to th est ePmy kno ledge. I have read the con litions ofapproval and I understand them, and that I will abide by them.
%,
Signat e Printed
AI' ROVXL INF RMATION
D.j . pp'. --ed as proposed ( I Approved with conditions ( I Denied
[ ) ' /Ilow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 17.
[ ] No physical site inspection has been done for this clearance. 'T'herefore, it is not a determination of compliance with the existing
site plan.
[ l This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official Date
Other Official f1 Date
I t
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/112011 Page 2 of3
Intake to complete the following:
Y '�'Jk
Is use in LI,1-II or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
l' i N
'ill there be mood preparation?
[fso, give applicant a I lealth Department form.
Zoning review can not begin ntil we receive approval from Health
Dept. FAX DATE Z,:, / 2
Circle the one that applies
Is parcel on private well o Aa;;' ?
If private yell, provide Hertment form.
Zo ning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that pies
Is parcel on septic (pr public sewer?
Y/\
Will you be putting up a new sign ofany kind? If so, obtain proper
Sign permit.
Permit 4
Y,'N
Will there he any new construction or renovations?
If so, obtain the proper Permit.
Permit tl ^2dJ% &2-7 AC,-
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: Zy / 3
� / N /
Permitted as:
Under Section: L �%
Supplementary regulations section:
Parking formula:
Required spaces: j
Y 1(N
Item ie verified in the field:
Inspector : Date:
Notes:
'VioIntt ns:
Yi C
Ifso, List:
Proff s
Y/�
IfsolI�iSt:
Vari ce:
Y /l )
If so, List:
SP's:
/N
If so, List:
(3,a-5y
Clearances:
09 - -2--j 6
SDP's
p 9-- /45
n� -/413
Iys
Revised 7.'1/2011 Page 3 of 3
A'
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompun?v Zoning applications (Hone Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Buil(ing Permits) if the application is not the
owner.
I certify that notice of the application, _ x' /7 1 / ' 1Ge°r -
[County application name and num er]
was provided to (il ! �/ 76;X) ^WV1A" th� ner of record of "fax Map V cr.-
[name(s) of the record owners of the parcel]
and Parcel Number l 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]
Oil
Date
Mailing a copy of the application to (jJ h,7 Tr /i% �IC fHP/Ir�
[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 ��l—� to the following address:
Date
Z-Z1a ,5_.
[address; written notice mai led to the owner at the last known address of thd'o-,Nmer as shown on
the current teal estate tax assessment books or current real estate I sessm ecords satisfies
this requirement].
Sign dire of Afiplicalit,
Print Applicant Name ---
Date