HomeMy WebLinkAboutCLE201300067 Legacy Document 2013-04-22Application for Zoning Clearance`
OF AI.
CLE # I �J W
OFFICE U E O Y f�
PLEASE REVIEW ALL 3 SHEETS
Check # _ Date:
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: T8- Si J Existing Zoning
Parcel Owner: 1'��t'4
Parcel Address: ASS j64e_( 4c � FMS "�t -� ftr9yCity('\'r- j -If State Zip 7
(include suite or floor)
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PRIMARY CONTACT
Who should we call /write concerning this project? ( °L 1n
City lU ) I4tate ' A- Z►po ,-
Address 500 ly
Office E -mail 'r1i 1 L
Phone: 2E
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: T�
Previous Business on this site A
Describe the proposed business including use, number of employees, number of shi ts, available parking spaces, n .Inbe S f
vehicles, and qny additional information th .yo n provide: �" '°
CW
c� -o a _
tihis Clearance ' 1 , ly 15,6valid o�parcefor it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
permissio a space indicated on this application. I also certify that the information provided
I hereby certify that 10 or have th owner's o
is true and accurate to he b st of m I h ve read co ditions of approval, and I un tand them, and I will.abide by them.
76t
(owledg ,
Signature l 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, 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:
Date I 1 f f
Building Official --�—
Zoning Official Date
Other Official Date
County of Albemarle Department of i;ommunny Le—upl ivuL
401 McIntire Road Charlottesville, VA 22902. Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Y
Is u ' LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi re 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: `t Z /S
(9 / N
Permitted as: g4 j "L4 011 Lov
Under Section: 7—S'A 'Z - )
Supplementary regulations section:
Circle the one that applies Parking formula:
Is parcel on private well r public watery
If private well, provide Healt epartment form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Circle the one that applie
Is parcel on septi r public sewe►?
Y
Il yo e putting up a new sign of any kind?
Sign permit.
Permit #
Y/N
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, obtai pthnr-r P rmit.
Permit #
Zoning to complete the following:
Violations:
Y /iV
If so, List:
Proffers:
61N
If so, List:
Variance:
Y /(�
If so, ist:
SP's:
0/N
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 or Appeals, 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
[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].
Print Applicant Nay
0 o ZoI-
Date