HomeMy WebLinkAboutCLE201300016 Legacy Document 2013-01-30Application for Zoning Clearance
CLE # �
OFFICE U N Y 1,2610
PLEASE REVIEW ALL 3 SHEETS C
Check # Date:
Receipt # S
PARCEL INFORM T QN ' T
Tax M ap and P
Parcel Owner:
�V State Zip
Parcel Address:' amity �
(include suite or floor) -
PRIMARY CONTACT
Who should we I
Icall/write `concerning t
# 1
Office Phone: (_� t Cell #
County of Albemarle Department of uommumty iieveiopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
)I
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /'M�f
Wil 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 r public w. er?
If private well, provide Hea epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or ublie sewe .
Q/ N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wil . ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin :
Reviewer to complete the following:
Square footage of Use: `- b
erm tted as: G� 1 iTG4ii 1
Under Section: ;g, Z. 7-
Supplementary regulations section:
Parking prmula :. I
Required spaces: q
Y( /(N)
Item o be verified in the field:
Inspector : Date:
Notes:
Violations:
O/ N
If so, List: 1
Proffers:
Y /�I
If , L]st:
Varia ce,
Y13
If so, List:
SP's:
Y /IO
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
f' "
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,
[County application name and number]
was provided to
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
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
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
to the following address:
Sl"'+(�!t IS66 Dr*&,ar, L&-Ac Cot(,�IUAC' QOQ
[address; written notice mailed to the owner at the lah'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].
Sig i ture of App cant
L40CA � ca!�e
Print Applicant Name
Date
G�� S