HomeMy WebLinkAboutCLE201300056 Legacy Document 2013-03-29Application for Zoning Clearance
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OFFICE USE QNLY
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PLEASE REVIEW ALL 3 SHEETS
Check # Date.
Receipt # _ Staff:
PARCEL INFORMATIO j��q,,,� ,�
FJ5f` `� A ( Existing Zoning t(C�.(X-
Tax Map and Parcel: I
Pa rcel Owner:
Parcel Address :-S t1q% 6ol F Drive- City LIKOZ - State VA Zip Z2g3Z
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? �Q nd l (t) 11no—C
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Address :.� L1gl0 60 1,4 /91-1 ✓e, City C rU2,�"� State If',4 Zip 9,3Z
Office Phone: S?�I CCj)Cell # 5ax # E-mail ,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
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Business Name /Type: ; Co rn loo Wt
Previous Business on this site Cq n I -F Cou rsL D e.&-1 o p lm ein 4 Qy � �Ce�
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 , oil
t 7-5 Zz) �5 tr
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* his Clearance will only be valid on the parcel for which it is approve t, If you ch , intensify or m ve 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 accurat to the b st of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
% 'J �o%ne
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Signature Printed /�� h�i -T
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.
[ ] 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 �- Dated C
Zoning Official ! Date 6/ 3
Other Official Date
County of Albemarle lllepartment of UommumLy LeMUPH,enL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
YYl
Intake to complete the following:
Is/
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
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
Circle the one that applies
Is parcel on private well o Cpub If private well, provide Hepartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Reviewer to complete the follow`` ingg: /
Square footage of Use: 51,
/N
GL e
•miffed as: Air C;� oT i 7� ��
Under Section: A-. Z
Supplementary regulations section:
Circle the one that applies
Its parcel on septic public sewer.
Y/N
Will you be putting up a new sign of any kind?
Sign permit
Permit #
Parking formula: 2 �1
� au ti
Required spaces: 1
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
Y N Notes:
Wi re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to emmnlete the fnllnwinu'
xViiolations:
!J1) / N
If so, List:
Proffers:
N
so, List:
6'1- Z y
Variance:
Y/(
If so; List:
SP's:
( /N
If so, List:
6 y3
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 or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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
[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].
Signature of Applicant
60d,' Cbmcr
Print Applicant Name
��Z (e1l3
Date