HomeMy WebLinkAboutCLE201200233 Legacy Document 2013-01-16IMMEM
Application for Zong Clearance
OFFICE U E ONL Z
Check # Date: IQ N
PLEASE REVIEW ALL 3 SHEETS
Y(1
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: $ tii t' �! - Z IJ - > Existing Zoning - �a��C16 c�
Wa!Yr��c(d gCiJai;/i�r'a�1
Parcel Owner: C- 1"Ce-n�i1 cr j -r-o.l &oZrrT% Uc-
Parcel Address: City 614v.1 1 o77e,5 1 e State t14- ZipZZw
(include suite or floor)
PRIMARY CONTACT C
06LA
Who should we call /write concerning this project? V
Address : Z�� Cu-! I �n , ` City. G ii1Tc5v+ 11e- State U,+ Zip zz z
Office Phone: Ctoq) ?(7 - U(Z- Cell # q(-0- ,0q%'5 Fax # Z93 - 31ST E -mail 5u7'c)'i!l !� T t9eI�CJe�•CQis1
APPLICANT INFORMATION
Check any that apply: Change of ownership^ Change of use /_Change of name New business
Business Name /Type: (i- (GC �li cr l - Pi �� V e/1 GX X01/
Previous Business on this site CJ`�GC/6'Pri �� T- (f Y-,�,cG
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: `,.�� 5?�TiO/l G� iT k l�rvt ye,.t i Sn Gee SCti
�-.� Z W w �►1 �-_ ��y ���
*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 in owledge. I have read the conditions of approval, and Iunnderstand them, and that I will abide by them.
kA 41A
Signature Printed el-6
APP ROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
-E- ]Cktl�vprevei�tis� ice 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 ;l�
I fZoning Official Date I 1 1 3
Other Official "- Lag 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
� rr
Intake to complete the following:
Y
Is On LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there 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 = I ➢�`3 I ➢
Circle the one that applies
Is parcel on private well o ublic water?
If private well, provide He i form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that Cies Is parcel on sep tic r?
g / N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit. 2 ,
Permit #� :1L1�)
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# B2012- 0148 -NC
Zoning to comnlete the following:
Reviewer to complete the following:
Square footage of Use: �6 10
N
as:
Under Section:
Supplementary regulations section:
Parking formula:
)�,
Required spaces:
Y/N .
Items to be verified in the field:
Inspector:
Date:
Notes:
Tz CU 4—h haul r l� -,,N
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
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, B2012-01048-NC
[County application name and number]
was provided to David Sutton the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 0 61 W 0 - 0 2 - 0 B - 0 0 3 0 0 by delivering a copy of the application in the
manner identified below:
1 Hand delivering a copy of the application to David Sutton
[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 08/30/20.12
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].
rrint Appiicam name
08/21/2012
Date
%.A alp,
• Application for ,Zo ing Clearance
<
-`y
CLE # 2.012 .
OFFICE U + ONL l Z
PLEASE REVIEW ALL 3 SHE, 9TS
Check # Date:
Receipt ## StAff:�-
PARCEL INFORMATION q
Tax Map and Parcel: , G (• W Existing Zoning
Parcel Owner: A/d�Ver7'Y , 1,
Parcel Address: City 614v oye'W lle State Ilk Zip 2=2:
(include suite or floor)
PRIMARY CONTACT ��� �����
Who shoidd we eaWwrite concerning this project? !/�
Address: Z!Q 6"'A 70A ! t City. t (jTresvi if e. State U,+ Zip 22��
Fax #E -mall i
Office Phone: (43 ), 8(7 —1�(L. Cetl ## 6q- 0q(a �
APPLICANT INFORMATION
Check any that apply: of ownership Change of uNe _Change of name New business
'Change
BusinessName/Type: Lr(e,e,�r1 cl 7— lot -e,Uell GA� FX ",v,
Previous Business on this site eYI.�G'G
Describe the proposed business including use, number of employees, number of slilfts, available parking spaces, number of
vehicles, and any additional information that you can provide: &t&2 Ow-TAW—A M! ! 4M 90'a L " St i'e -
,,-Ag 1W W-W IA
*This Clearance will only be valid on theparcel for which it is approved. If you change, intensify or move the use to a new toot ion, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owneespermission to use the, space 'indicated on this application, I also certify that the information provided
is true and accurate to the best of my owledge. I have read the conditions of approval, and I u�n�dllersiand them, and that Twill abide by them.
��
Signature Printed t�dt'L�
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions .., [ l Denied .
( ] Backtlowprevention 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 R determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Buifdnng Official Date
Zoning Official Date
Other Official to 0 %Z-
County oI Aincrunlie AJeparument Or I- muultuitty Luvnturit.uctit.
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax, (434) 972 -4126
Revise% 711/2011 Page 2 of 3
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