HomeMy WebLinkAboutCLE201300034 Legacy Document 2013-03-15CPU,,
Application for Zoning Clearance
CLE# — Z
�RChN�P
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 0- 65 Date:
Receipt # q01 Q Staff: Joy % ,e
PARCEL INFORMATION
6 / "- I y 7 el
Tax Map
and Parcel: Existing Zoning
Parcel Owner: lGYle/
Parcel Address:-10'111 5- P- a 2r,,,d City CGS r (e'l{est-%//e- State Of Zip � �9°
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? /u rJ a 5 Q> 4-1
Address: (o t b r. City CL,-" I. ' I er v ale_ State ��j¢ Zip ZZq !/
Office Phone: y( 3`l ) 9 7S-- 5'-zoo Cell # so 3 Fax # 93q - 975'--'9q 73 E-mail 1Vl I '/`4 N o 1 Sao I . co
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use K Change of name New business
Business Name /Type: Glee M
Previous Business on this site Ce- Lovers 6kr 0,-s 1
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: C4, i✓�s �, otie eLyplo y.ee one
*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 pennission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand theirs, and that I will abide by them
Signature Printed �✓' �� 1 �� 1, ca.5- cb
AP.P'ROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
eopphysical
[ 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
Zoning Official Date
Other Official Date
wunty or AiDemarie uepartment of Community Development
401. McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126
Revised 7 /1/2011 Page 2 of 3
Intake to complete the following:
Y/@
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/
Will t ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fiom .Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o u_b_lic water?
If private well, provide Health ep ent 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 p blic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #�
Y N%
W' there be any new construction or renovations?
If so, obtain the p oper Permit.
Permit # � . '0
Zoning to com lete the following:
Reviewer to complete then following:
Square footage of Use:
Y N
ermitted as: - V �► l�G�i`�N I' ' C
Under Section: 2�
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
le
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Varryp' e:
1' /t�
If so, sst:
SP's:
Y/N
If so, List:
Clearances: n� � � � I � r � �
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, _A , r-a
[County application name and number]
was provided to / �Y (o,� �L� ope�.� G ry .-P the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 6 l - I X17 -f by 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]
on
Date
Mailing a copy of the application to Y (. " '!�X-ve W-_
[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 %Zr�r3
Date
to the following address:
I(, q-5 weS4�4 &, -, `�lsa9� W,Lisf�. — S�lewi /VC '27!133
[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].
Signature of Applicant
); l'I'a,,, J G-s �,,
Print Applicant Name
?-/7-1 /i3
Date
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