HomeMy WebLinkAboutCLE201300008 Legacy Document 2013-01-14Application for Zoning Clearance
CLE it
0
OFFICE USE NLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date: -
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: .407 %; #07800- 00 - 00 - O 15C-rn Existing Zoning H Way/ Comm► U`0.,
Parcel Owner: -P1e- PSV&, 1I&5T1C_�fodPJ( "fieS .l. L
-40At
Parcel Address: 1-75'S. c%-A +IDS br, City ��f'�b F'�C,SVI(�tate ' f ZipR;A t 1
(include suite or floor)
PRIMARY CONTACT
�,,��
Who should we call /write concerning this project? LV�1 �� d�SM UISSP —VI
Address: 175 5. ?"fops fir. City LIAn.0 IoHe -sJt I I State [i 10. Zip Dian � I
Office Phone: '1(_ 9796- 97 &10 Cell # &05°-&9o1- 9a1 *ax #131 - 2910- 11!15. E-mail Forowl;cEia)""ovi 5=1'ce
eo. 31 vat I . CM M
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _New business
BusinessName/'Type:�t�li•tnSiG Ei�0.�u0��loVl�l'VICeS�� i�Irir ✓0.1��,oACi'��C�
Previous Business on this site Friy&Ae, t'SV�'1a+rV Prb_C.Ti�E cL Ir. B'M �cpX
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: tAoa o a n eel
' idUals' a erg o un k'n '
ki l 5e e- a 4%. a a.w. 'Sole 1 `o
*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 them, and that I will abide by them.
�NWJJ1
Signature Printed �tE 70S1M1ASSCtA
APPROVAL 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 I'i / Y
Zoning Official Date & � 13
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:
Is%
Is usdVn LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will 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 ubli ter?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one thaw
Is parcel on septic o ublic sewe ?
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: /;0
0/N
Permitted as:
Under Section: �• 2 `
Supplementary regulations section:
Parking formula:
Required spaces: /
Y /
Items to be verified in the field:
Inspector : Date:
Notes:
Viola ions:
Y/
If so, ist:
Proffers.
Y/0
If so, List:
Variance:
Y N
If so,Zist:
SP's:
Y /
If so, List:
Clearances:
SDP's
6 7— /
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, Awl i r&44c VI 'cOf ZoVlt VUL Cl ro►y1eG
[County application name and n tuber]
was provided to ?(Q�y►Aoy + ?5VQ &+1U t - 1 ( bDefiie5 jnc the owner of record of Tax Map
[name(s) of the record owners of the pa cel]
and Parcel Number _by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to �Se ear I es t'
[Name of thd 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 O 1%11 Zao E3
Date
Mailing 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
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].
ature of A licant
��"Vl1' ef ia SVWuSSetn
Print Applicant Name
Date
5'
Sketch
This is a single room office on the second floor, in the most north western corner of the
building, and approximately 180 sq. ft.
11%