HomeMy WebLinkAboutCLE201300022 Legacy Document 2013-04-17T
Application for Zoning Clearance
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CLE 2013-22-
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OFFICE USF O
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PLEASE REVIEW ALL 3 SHEETS
Check # ' Date:
Staff: 1)
Receipt #
PARCEL INFORMAT O n r '
/'D a' �mr! 04
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Existing Zonin d
Tax Map and Parcel: CJ- ! g
Parcel Owner: 9"wk0oc" PL(kzG.. PLC
Q �/ i
Parcel Address: (7 5 R, 41 n n C,,. 0 IC lo-� l),c City C of � (N)N Vi '11 �. State \Z& Zip a 6
(include suite or fl or)
PRIMARY CONTACT (�
Who should we call /write concerning this project? C,
Address: )-folk, Hlo n, City State vj� Zip 2Zci.3
Office Phone: L� �J /�� Cell # q3y -L{ G6- 9 3- ._'7Fax # MIA. E -mail ,� �, �c1(e ye.C? 5k� k4rn i`. Lrn
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Lee's Nct�ls
Business Name /Type: C i Sc�1nC1
Previous Business on this site /,jZA
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: ` fi
do4pmm
7 P leb, s 'Wlrmi!!��:::
L 4 N rJn � � e h�cl WD
*This Clearance will only a valid o he p rcel for which it is approv d. If you change, intensify or move the use to a nevy I�jcati n w g
1 �rM .
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 he best of my knowledge. I have read the conditions of approval, and understand them, and that I will abide by them.
//I
Signature 7 Printed �U116 00 n
APPROVAL INFORMATION
54 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 �_II r ! ( Z
Zoning Official Date
Other Official Date
County of Albemarle Department of uommunity LeveropmenL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
c-X%14
Intake to complete the following:
Y /Q
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will 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 or ublic wate .
If private well, provide Healt epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or ublic sewe'?
Y@/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # N/A i l4 1)) Zee O z C1 to u.N c (z--
i3 Cov�(�ICke&
W be any new construction or renovations?
If so, obtain the proper Permit.
Permit
Reviewer to complete the following:
Square footage of Use: 7'-3
0/ N
ermitted as: 5x l� rJ
Under Section: < y_
Supplementary regulations section:
Parking formula: /
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
- -- - - - -- - - -- - - -- - - -. - -
Violations:
Y /
If s /o`Di'st:
Proffers:
Tf/N
f so, List:
Zr�� 95-7
Variance:
Y//N
If so, t:
SP's:
f so, List:
y, 7'z-
n7 -5C
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, 2pr1; n G CIecacc vi c, c,
[C my application name and number]
was provided to RiNi n nG- QkxZ LLC., the owner of record of Tax Map
[name(s)-of the r cord owners of the parcel]
and Parcel Number M 5 (DC) -UU r CO dC(d O by delivering a copy of the application in the
manner identified below: nA
�/ Hand delivering a copy of the application to / _ICj Y Carr ,z n
[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 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].
nature f Appl cant
7) 1 Q
Print Applicant Name
/A0//3
Date
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