HomeMy WebLinkAboutCLE201300024 Legacy Document 2013-02-19Application for Zoning Clearance
5
CLE # 2,6 I- - 2A-
.. L�hYi1N�r
OFFICE US� 1�J Y
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff: J
PARCEL INFORMATIO
Tax Map and Parcel: __L01 U t - 0 Existing Zoning
Parcel Owner: `m �z • l Q-Q C 2-12(n L-`—a
Parcel Address 15)0 )E)Q►' tlirA �/l�ie. State VG Zip 2?
(include suite or floor)
PRIMARY CONTACT
J2r►�,r�
Who should we call /write concerning this project ?�f� 11��
Address C City � � State V q Zip
L43 _ ((�� \\ j� ,�, j
`J E 01.
Office Phone: U'2913gLt0(P Cell #. Fax # -mailu J
0 110 Z75�1
APPLICANT INFORMATION
Check any that apply: of ownership hange of use Change of name New business
nnChange
Business Name /Type:
Previous Business on this site, �` -/on_n l QQ ���� uV
Describe the proposed business including use, number of employees, number of shifts, vailable par ing spaces, number-of 47
'Y� IZ_iY P
vehicles, and any additional information that you can provide: �� f r
*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 acc P;al-Cp the best of my knowledge. I have read the conditions of approv d I understand them, and that I will abide by them.
Signature Printed
APPR✓ AL INFORMATI
[ ] Approved as proposed �C] 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. `yam/ , (�
n(�.��1 Vh' !� kI I
Notes J Pi d c�
Building Official �- Date E, f�
Zoning Official Date�� -��/ �Zc�
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:
Y .N
Is u n 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 o public water?
If private well, provide Hea artment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that Zp nblic Is parcel on septic we r?
KY
I you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # 1 i
Y
Wil re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7- r* +.. .,ln +n +h. fnllnxx�in`r•
Reviewer to complete the following:
Square footage of User J
y/ / N j
Permitted as:
Under Section: Z �/ • Z ,
Supplementary regulations section:
Parking formula: I
Required spaces: Z
Y/O
Items to be verified in the field:
Inspector : Date:
Notes:
Violati. ns:
Y /(�I�
If so, I
Pro€
Y/N
If so, f ist:
Vjriance:
k /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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to m Q • (0 Q
[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 ::2, L 2OI
Da
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].
-;9 I'q' 12-01 e-b
Date