HomeMy WebLinkAboutCLE201300055 Legacy Document 2013-03-29Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
Check
"L' # Date: L
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
Parcel Owner: L I u p bLAYc--�- 6;aE� LE ti LLC.
1133 �r,� vQ�3 j
Parcel Address: _Cia -rnr n(,, fl City OVA. r lbftc:)%V� �1 e-State Zi,
(include suite or floor)
PRIMARY CONTACT
Who
should we call/write c this project?
/oncerning
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Address : �Z3 MC)Ij 1"Fexdo 01 City�iY�CltCtDAeQL1(,0 State Zip`).a9D 1
Office Phone: 63tO 0 y 4 -Dq0:�- Cell # Fax # E -mail \00-\Cc� b.Qakci �- ao l -
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: _ eta i 1 ( --'� 'L_Lo
Previous Business on this sited \10t�{�
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: A .ra ;e ca r) D
�0 aVVAM S Q� ,
*T�us 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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
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Signature [ Printed e (_� 1p
APPROVAL INFORMATION
[>j 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 3
Zoning Official Date
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
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Intake to complete the following:
Y fin)LI, Is III or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Wil 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
Reviewer to complete the following:
Square footage of Use: /I U �
®/N
Permitted as: j
Under Section:
Supplementary regulations section:
Circle the one that applies Parking formula:
Is parcel on private well �water? If private we ll, provide He rm.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE J
Circle the one that ap
Is parcel on septi r public sewer?
Y I/ N
Will you be putting up a new sign of any kind?
Sign permit
Permit #
Y /A
Items to be verified in the field:
If so, obtain proper
Inspector • Date:
/ N Notes:
ill there be any new construction or renovations?
If so, obtainAe prope Permit.
Permit #
Zoning to complete the following:
Viola 'ons:
Y /(f)
If so, List:
Proffers:
Y/Q
If so, ist:
Variance:
(3F/N
If so, List: �6-7-7 L/
SP's:
Y/10
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 orAppeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to L �nAc, ��G �6 \-per the owner of record of Tax Map
[name(s) of the record o4ners of the parcel]
and Parcel Number �i \.� — 3 —a �- 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
�V Mailing a copy of the application to 1 6
[Name of the record owner if e 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
to the following address:
F0- Rex g5-74 E U-P 9o,5-.
[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].
Sigma e o Applicant 11
Print Applicant Name
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Date
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