HomeMy WebLinkAboutCLE201200246 Legacy Document 2013-01-11Application for Zoning Clearance
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE, O Y
Check # Date:
Receipt # Staff:
PARCEL INFORMATION n
Tax Map and Parcel: .32- Existing Zoning A,h Uo-i 64'Mercl'C'r
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Parcel Owner: SLkY)se+
Parcel Address,3 5z) Ste,; .iyrz i,(al I , 5m' "' 10 City ck(A► ,11Z State 1� Zip it I
(include suite or floor)
PRIMARY CONTACT yl �,a--,��
��5 I � Wr'-A 'BATS J
Who should we call /write concerning this prgject? WL l
Address : 345o sQnAc 7r-e`A city state VA Zip ?14
�7 `l3�Se� .--- -- _ s
Office Phone: ,3 .3 Cell � 577 � Fax # E -mail �l'l � i aj� 51 p5 , C.t77y1
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: "Dj 6 1X!5 I Q S ACE C�
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, avail ble parking spaces, number of
vehicles, and any additional information that you can provide: `Z'C� �CA-N1 P L�� =&=X 5
F',,uIFLoJ EIS , '2, S. F'7 S. A R- e- ftl 'R� I;giLbIrJs -i Gts'To K P-
IN T RR
*This Clearance will only be valid on the parcel for which it is approved. Hyou change, intensify or move the use to anew location, anew 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 o the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed k�/�+GI
APPRO AL INFORMATION
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 I P I 'Lo f/ L
Zoning Official Date' &4A-')43
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) Z96 -5832 Fax: (434) 97Z -4126
Revised 7/1/2011 Page 2 of 3
I
Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use: �!
Is us in LI, HI or PDIP zoning? If so, give applicant a Certified
O
Engineer's Report (CER) packet.
/ N
Y
Permitted as: Ctfk�al
Will ere be food preparation?
Under Section:
If so, give applicant a Health Department form
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
y Z
Dept. FAX DATE
Clearances:
Circle the one that applies
Parking formula:
�ilo
Is parcel on private well o ublic water.
If private well, provide Healt ent form.
Zoning review can not begin until we receive approval from Health
Required spaces: 1
Dept. FAX DATE
l
Y/
Circle the one that apgkes ---1
Items to be verified in the field:
Is parcel on septic o r public sewwee ?
Y /`0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Perri t #
Inspector : Date:
Y O
Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
N 'olations:
IN
If so, List:
offers:
P /N
If so, List:
Varia ce:
Y /<i
If so, List:
SP's•
Y/�
If so, List:
Clearances:
SDP's
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, I ccc M A r 7oi�t gq C %q ratj(-,er
[County application nakie and number]
was provided to SLkylslo—+ L.-L.0 the owner of record of Tax Map
[name(s) of the record owners of the parcel]
.and Parcel Number 4 3 a 6 (c- xr d8 a -377 1 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
ailing 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 l Zb %- to the following address:
Date
20 16WbfMk �lfir„
[address; written notice mailed to the owner at the last known address of the owner ah shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement],
a of Ap t
Print Applicant Name
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Dat