HomeMy WebLinkAboutCLE201300050 Legacy Document 2013-03-15Application for Zoning Clearance
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OFFICE USG N n
PLEASE REVIEW ALL 3 SHEETS Check# �� q2 Date: D " 2 �0
Receipt # Staff: rin
PARCEL INFORMATION
Tax Map and Parcel: '7At, Q bl i S-al) - Da— D;7 6b �.CQ Existing Zoning e (
Parcel Owner: 627 8 �7 �6 PER % /a�, /_ LC
Parcel Address: 1 143 �tw 7IJLl�� % '� City (.Mj_0aVZ=25U /Mate y -A' Zip 3 ��
(include suite or floor)
PRIMARY CONTACT nn
Who should we call /write concerning this project? /CE �. I rn 6 ti S
Address: 'PU. ZbX 13y7 Cityh04'ettiG4&uGState 1f6 • Zip c o`gg!5;
Office Phone: (� y�) h�3 - 9D"13 Cell # 40 -• (C$,!y7Fax # �IfZ� -- 9"IbbE -mail %i t,Y. 6i on Olbt,,�6 PA--V rz'emt
ez:
APPLICANT INFORMATION
Check anv that
Business Name /Type:
Previous Business on this site
of ownership ✓ Change of use
lam r��T��ifl��
IC�9 TA/
e of name 0' New business
Describe the proposed business including use, number of employees, number of shifts, available parki g spaces, number of
vehicles, and any additional information that you can rovide: �StxPP�y e F L'261j b-Z Cti�7 KCi; t
A NQ Eaz�s2�1Z1 DrJ i�QE��t�CZ PfWeg 7e -e,45 y f= U Li_ -- j77/
"This Clearance will only be valid on the parcel ibr which it is approved. ifyou change, intensify or move the use to a new location. a new Z.,onir
Clearance will be required.
I hereby certify that I oNam or have the owier's permission to use the space indicated on this application. 1 also certify that the information provided
is tr ue and accurate etto the best ofm f laiowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ';_
S
APPROVAL INFORMATION
Approved as proposed ( ] Approved with conditions [ ) Denied
( ) Backflow prevention device and /or current test data needed for this site. Contact ACSA. 977 -4511. x117.
[ J No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official �. _
Zoning Official
Other Official
Date 3(($
Date .j/ / �, a/3
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 of3
Intake to complete the following:
Y /CN,,'-'
Is use in Ll, 1-I1 or PD1P zoning? If so, give applicant a Certified
Engine`err''s Report (CER) packet.
1' / ne
Will there be food preparation?
Ifso. give applicant a Health Department 1b1-111.
Zon ing review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or p�epatnentlfbrnl.
If'private well, provide Healt
Zoning review can not begin until we receive approval f•om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer?
U/ N
Will you be putting up a new sign of any land? Ifso, obtain proper
Sign permit.
Permit# 7'�6AJ4jX (L,
LY-3/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit# AeA;1li-(,
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: 33;-11/
Y/N
Pcrmitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector: Date:
Notes:
Violations:
Y / N
If so, List:
Proffers:
Y / N
If so; List:
Variance:
Y / N
Ifso, List:
SP's:
Y / N
If so. List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form Hurst accompa» y zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Deterininations or Appeals, Sign Permits, Building Permits) if the application is not the
owner:
I certify that notice of the application, AKLkCAZ►ati Ft Q- ZalJIOG CL-pga�
[County application name and number]
was provided to >Pi�► �S1�pAt✓ R`r1 5 L L1- the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number '7"m : 4, 1 dE 1 U,)b -o a -4 A "Dd delivering a copy of the application in the
manner identified below:
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]
Oil
Date
�! Mailing a copy of the application to 4z-' -PER 's I-
[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].
W7A
Signature-01 Applicant
Print Applicant Name
d'�.L:�'.t3
Date
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-PRE- ENGINEERED STEEL FRAME BUILDING WITH
METAL SIDING AND CONCRETE FLOOR