HomeMy WebLinkAboutCLE201300037 Legacy Document 2013-03-01Application for Zoning Clearance
CLE # r c)(3— 37
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # Date : —1
Receipt # qOV29 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0�666(p `" oL ^- 00 ` ���C -/ Existing Zoning ��MtV�ri
r k1- `rJ e- e `r �e��1 Uh � rr,
Parcel Owner: t /Q���
Parcel Address: City -/�� °(State V e�G% Zip ?y
,Zj.� � y
(include suite or floor)
PRIMARY CONTACT � //
/ /140 #�04-
,� � 11
Who should we call/write concerning this project? !C�'1 Gl ✓
f"a
Address: l L%0l> (l /Llj� ,0?C;L /�%l (%� City C�"!01-16f� AeState !/11 -q/'/? 1 a Zip
Office Phone: 111 96-7 `(0C ell # (� Fax #
APPLICANT INFORMXTION
Check any that apply: Change of ownership Change Change of name New business
/lfuse
f7S�1lrjt- ���11C� ejlf -�.�
Business Name /Type:
Previous Business on this site
Describe the proposed business including use, number of employees, number of, hifts, avails a parkin ,g,spaces, nu her of
M9510 �°. ►' M
vehicles and any additio al information that you can provi ,r! S4 !aA-,-
e 1''s vv-
roElY1 ' e� G7 �. �Ci f C�iy! G� x'/Vf t
*This Clearance A only be v >Kd onihe parcel for which it is approved. If you change, intdnsify.6r 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 accur o h best of ow dge. I ve read t econditions /ofapproval, a�nd�I�u�nderstand t m, and th/a�t I�will abi e by them/'
�L��pr;nted
Signature ��� L¢�`� ll'y"'r itlC��Zy
AP OVAL 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 �-G
Zoning Official Date
Other Official Date
County of Albemarle Department of Community ueveiopment
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
4
I
Intake to complete the following:
Y /�Is use n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will t 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 ublic water.
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o lic sewer,
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will tre be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7—n" to rmmnlntP the fnllnwinv-
Reviewer to complete the following:
Square footage of Use: M
/N
•miffed as: ll
Under Section: -a
Supplementary regulations section:
Parking formula: t
i,, Y) & flame
Required spaces:
Y/N
Items to be verified in the field:
Inspector•
Notes:
ate:
Viol, ns:
Y/N
If so t:
Proffers:
Y/N
If so, List:
riance:
Y N
so, List: � �
's:
Y/N
f so, List:
Clearances:
'
SDP s
Revised 7/1/2011 Page 3 of 3
Ira
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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 notici\of the application,
was provided to
[name(s) of the
and Parcel Number
manner identified below:
Hand delivering a copy of the
person; if the owner of
title or office for that ea
on .
ate
[County application noRre and number]
owner of record of Tax Map
owners of the parcel
by delivering a copy of the application in the
Name of the record owner if the record owner is a
is an entity, idea 'fy the recipient of the record and the recipient's
Mailing a copy of the application to
11U I�+ LI--C�
[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] 22
on J to the following address:
Date
L(
volt -e,
[address; written notice miled 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].
Signature ofATrlim rt—
Print e
Date