HomeMy WebLinkAboutCLE201300002 Application Zoning Clearance 2013-01-07Application for Zoning Clearance
CLE
OFFICE U 0 'Y
i
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Staff:
Receipt #
FP�ARCEL NFORMATION 0 l c,Q — Parcel: O(Qlwa)D /bi W ' Existing Zonin:
JC�1Y) avy?2'
Chti�9o�} -r3,� state a 1
City U A Zip
Parcel Address:
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
�agol
Address • ��0 CoY�YheG� City Ch�rjQ )i21�i1�2 State Vii Zip
Office Phone: L,q) Cell # Fax # E -mail
14 q's - ga'3— 96 C3f0 U-)C la+�o'tmi)tt h,rder)-)-0l Cn c] r,�q� 1• CQ
APPLICANT INFORMATION
Check any that apply: ✓Change of ownership Change of use Change of name New business
���rl��%eSNiI� -jv2 R\C)�t "bov)-i-ea, PLC t-2_
BusinessName/Type:
Previous Business on this site �')4 �[ve R)62L&
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: DV))
�°0 a t'e
*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 of my knowledge. I have read the conditions of approval, and I understand tiiem, and that I/'will abide by them.
-- �_�- Printed SVi'64e jam / tt wl l&
Signature ,�!�_
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions j ] 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. • I
[ ] This site complies with the site plan as of this date.
Notes:
Building Official r Date [ z C 3
Zoning Official Date
Other Official Date
County ol'Albemarle mepartment of Uommumty yeva►up111C1JL .
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
CL
Intake to complete the following:
Y
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /Qero �'il 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 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 ublic sewer
Y
Wi ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/ i)
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin to com lete the £ollowin :
Reviewer to complete the following:
Square footage of Use:
6 /N• on
Permitted as: A �'f, (c;ft / di��C�o
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: -T-/
Y/A
Items o be verified in the field:
Inspector : D .9te:
Notes:
r
Viola ons:
YM
If so, List:
Proffers:
Y/
If so, ist:
Variance:
Y /(9
Ifso, List:
SP's:
Y!
If so, ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
U
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LA.NDOWNER.
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,h��Cq iC�YI der Zo��n �l�ra3�C
[County application name and number]
was provided to
�a n 9--hoeb
[name(s) of the record owners of the parcel]
and Parcel Number OU \ W a )-G
manner identified below:
the owner of record of Tax Map
(St — by delivering a copy of the application in the
Hand delivering a copy of the application to Sohn'
[Naive 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 / I I ]3
Date .
Mailing a copy of the application to
[ Naive 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
wlr u9 `-n Im) 4t., lta.
Print Applicant Name
Date
I : G