HomeMy WebLinkAboutCLE201300052 Approval - County Zoning Clearance 2013-04-26M
Application for Zoning ClearanceEi;'`
CLE # MIA
k �N
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # _ Staff:
PARCEL INFORMATION /��
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Tax Map and Parcel: j J -Qk� - Wino Existing Zoning_,, 1
Parcel Owner:
Parcel Address: k/.zj� 'G'IGC X,4j- City Cho- CD 1 State r/ Zip �• ��
(include suite or floor)
PRIMARY CONTACT n
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Who should we call /write concerning this project ?
A-- n // ff jj�� Ile
Address: ��l ROh %�1 ��/ City � Il/l G6L State Zipf
Office Phone: C__) Cell # y��l �76 �3Fax # E -mail i, o
APPLICANT INFORMATION
Check any that apply: of ownership Change of use Change of name New business
,,Change
Business Name /Type: !r/��•*! /n� y C%j1! �C
Previous Business on this site l G/ P.L!Y�Gt ���f/ t-Pih ! e4
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: ! ®�as� .75"s 7� Em _ �Leej
r i
*This 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 kno ledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Az Printed �C.1/t°i1') / �• Iy�r11' +�
APAL INFORMATION
[ P 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 c Date
Zoning Official Date kzw��y
Other Official Date
County of Albemarle Department of uommumty veveiopment
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:
Is/
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 1't
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 or ublic water
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 applie
Is parcel on septic or ublic sew
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign per ,i ,
Permit #
V Y }' N
ill there be any new construction or renovations?
If so, obt ' t e r er P t.
Permit #
7nninu to emmnlete the following:
Reviewer to complete the following:
Square footage of Use: �L4A
Permitted as:
Under Section:
Supplementary regulations section:
I 'fi 0153im
Parking formula: Ila
7
Y)
Required spaces: d I -
Y/N
Items to be verified in the field:
Inspector Date:
Notes:
V ypiations:
Y N f so, List:
�g� �L 1 q
J
Yr�fV
If so, :
Variance:
Y/N
If so, List:
((} (,�
SP's:
Y/N
If so, List: sop jq -0
Clearances:
�n SS
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:
the owner of record of Tax Map
by delivering a copy of the application in the
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
Mailing a copy of the application to c4il 9
[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].
Signature of Applicant
Ste ile,, /fir l�ih
Print Applicant Name
Date
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