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HomeMy WebLinkAboutCLE201300061 Legacy Document 2013-04-02OFFICE USE ONLY - Zoning_Clearance.pdf http: / /www. albemarle. org /upload/ images /forms_center /departments /... & "(-)I P , Application for Zoning Clearance��`� ,�,r, CLE # lro - 6 1 1 OFFICE Check # PLEASE REVIEW ALL 3 SHEETS Receipt #__ W)E)W Staff : V PARCEL INFORMATION Tax Map and Parcel: Q-% e d d - 00 - 420 / % H l Existing Zoning ���1✓ p- ''b Cl r 101 d (6ef j �5 ti'G'1 CrCD�� Parcel Owner: � � '1 Parcel Address: �rj �l rV���P/ �/-, IJhi City /0 State V GL zip 2091 (include suite or floor) PRIMARY CONTACT , Who should we call /write concerning this project? 'hY�t ll/ Address: � Ll 30 C! - "nI— si- 1 flq city Cb� 1 stage N G zip �aZO Office Phone: l & ) 3 :� 2 77 67Cen # PL k-- Fax # la1 9 � 2- 53 01fmail C1G� r� nt @ Gvsr��Qna� ems. �•�. APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: L&Z 'Id 9Gc /� / �-, Z r,G C Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional inform tii-on that you can provide: .� "This Clearance «ill 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 ivill be required. I hereby certify that I owti or have the owner's permission to use the space indicated on this application. I also certify that the infornratiorr provided is true and accurate to the best of my lalowledge. I have read the conditions of approval.. and I understand them, and that I will abide by them. Printed APPROVAL INFORMATION Approved as proposed [ ] Approved Aith conditions [ ] Denied [ ] Bacl&ow prevention device and /or current test data needed for tlus site. Contact ACSA, 977 -4511, x117. [ ] No physical site inspection leas 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 1� 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 Paae 2 o 3 2 of 4 3/20/2013 11:00 VIM i OFFICE USE ONLY - Zoning_Clearance.pdf Intake to complete the following: Y / 169 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/V Will there be food preparation? If so, give applicant a Health Department form. Zoning review can not begin witil we receive approval from Health Dept. FAX DATE Circle the one that applies --�-� Is parcel on private well or p blic � kef ? If private well, provide Health Department 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 ublM s er? Y /e Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: http: / /www. albemarle. org /upload/ images /forms center /departments /... Reviewer to complete the following: Square footage of Use: I3 00 0/ N Permitted as: o �-1 a l wen Under Section: J-5;' • ; Supplementary regulations section: Parking formula:� Required spaces: Y/ Items to be verified in the field: Inspector : Notes: Date: Violations: Y/N If so; ist: Proffers: /N so, List: J v Varia ee: Y /OT If so, List: SP's: Y /V If so, List: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 3 of 4 3/20/2013 11:00 AM EXHIBIT A Space Plan of the Premises 1300 rentable square feet 16 ti OFFICE USE ONLY - Zoning_Clearance.pdf http: / /www.albemarle.org/ upload / images /forms_ center /departments /... CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This forin must accompany Zoning applications (Hone Occupation, Zonin' Clearance, Zoning Administrator Determinations or Appeals-, Sign Permits, Building Permits) if the application is not the owner. I certify that notice of the application, ' 1 Gl C�ind� > 7 �C .. [Cotuity applicatio aine and' nber] 44SC'cvW-es was provided to �7^L � � rn eel1'LA'f %r'P the owner of record of Tax Map [narne(s) of the record owners of the parcel] and Parcel Number 01569 -- 2*2 --00 •- 02 7 P / by delivering a copy of the application in the rrianner identified below: Hand delivering a copy of the application to [ Nance 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 V/ Mailing a copy of the application to Si [Nance 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 � 1 7- 2� to the following address: Date [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 U c��rq he- 1,r'/--�� Print Applicant Name Date 4 of 4 3/20/2013 11:00 AM