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HomeMy WebLinkAboutCLE201300033 Legacy Document 2013-03-19Application for Zoning Clearance CLE # LE °` "'�' • 3 V- ., � OFFICE USE ONLY ti 4413 PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: , PARCEL INFORM TrION� Tax Map and Parcel: 21 D "Q, "' ��e � �� 2 _ Existing Zonin Parcel Owner: 1' � ���, • � + � .�[� 0 :W,V I Parcel Address: 7�+C�. a � ity tate • (� Zi022qQ (includes ite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Address : 1,9 aw, vhvee City State Office Phone: Cell # t4A Fax # /_ E- mail J�II� hT ClVY► APPLICANT INFORMATION Check any that apply: Change of ownership _.Change of use Change of name New business Business NamefType: _ Previous Business on this site Describe the proposed business including use, number of employ s, number of shifts. available parking s aces, number of vehicles and any addi nal infor anon at u can provide: (���jr" , (� d *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 accurate tQ thUrst of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed 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, x 117. [ ] 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 Zoning Official Date ,3,/L21,/3 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 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, An V way W! County applica ion name and htdnbe r] was provided to the owner of record of Tax Map name(s the record owners of the parcel] 174-ARY I rC- and Parcel Number(? A 1 f JIQ 41 i • 12 *W1 6:7. 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 ai ing 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�,�j. t �a t�j to the following address: Date [address; written notice mail to the owner at 1h e 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]. . '1s�4 WAM .� ' • I Intake to complete the following: Y /� Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /© Will there 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 blic water If private well, provide Health Department form.. Zoning review can not begin until we receive approval from Health Dept. FAX DATE ircle the one that appl' Si parcel on septic or lic sewe . Y N Will you be putting up a new sign of any kind? If so, obtain proper Sign permb2a" Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ZoninL7 to emmnlpte the fnllnw;no- Reviewer to complete the following: Square footage of Use: A/ 5s 2-t �/N 1 ermitted.as: r&-A Under Section: 2 S• L. Supplementary regulations section: Parking formula: I 1- ivy J Required spaces: Y/ Items to be verified in the field: Inspector : Date: Notes: Violat' ns: Y/0 If so, ist: Proff s: Y/ r If soot: Variance: r� /N If so, List: SP's: f /N If so, List: 9-D 20 qL/ 3 Clearances: SDP's 2 Revised 7/1/2011 Page 3 of 3 m1�o msaLw � v�grw�wmro uuw fLI%va ® ac Sfll ;letmrac aelwvaa Autlti t�ni r nl99. .• aOn• 9fu� ) � M 0o®d' R•u�oB�.nLrmm I� D ) ois .330H3YM 30HS 18 NJIS 0 MJQ ccm-r .a��.qv ac re o ca �[ru MYM axnrxr gn � iII;,lg;i�=e3:ct�ig1 1y �. 7 gAmp & oBF16A8I7 ?IF BM1 TLu c� } U & 4-gF9g U 1+°�4 �'E F— LL U U to 4 0 nn•• ELI$ [a p a IKI y5 d LIJ O= A__ ^ua +g�A�m n LL, Q D O 66 d{ U G[ti g 6. 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