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HomeMy WebLinkAboutCLE201300068 Legacy Document 2013-05-02Application for Zoning Clearance�i�jz_ yet nLU�t OFFICE USE N � Date: - PLEASE REVIEW ALL 3 SHEETS Check # - Receipt # Staff: PARCEL INFORMATIOYNY'''' � � � � fisting Zon gT Tax Map and Parcel: I/l1 ..,.. =. tyn& Parcel Owner: Pu Parcel Address: Qtvl -tr"Mo Jomxo- P12, City CV V State Zip (include suite or floor) PRIMARY CONTACT un:E Who should we call /write concerning this project? Address: City G l q� State \IAI • Zip -Id, Office Phone: Cell #X344 * -7 ax # E -mail ire APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name ✓ New business Business Name /Type: O&A' -a Previous Business on this site J 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: � _ to A;FN— V klAIA4E,; 6 UZk5la� _!"v- Q70211.SCCL CVAIS t _ r *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 permissi n to se the space indicated on this application. I also certify that the information provided is true and accura to the best f my kno I ,ge. I ha re the conditions of approval, and I understand them, and that I will abide by them. �- Sig- Printed ���✓ � ��-��''�'� APP VAL INFORMATION pppoved as proposed [ ] Approved with conditions [ J 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 —k-( -1 Official Date '�I h•� lc Zoning Other Official kPAAbn 'We Date county Of AlDemarle 1JepartmCn1 01 ♦.V111111u1111y yrVr, VVuaca.. 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 I- Revised 7/1/2011 Page 2 of 3 W - Application for Z . n1h: - � n. CLEF `6(3 °l6 OFFICE PLEASE REVIEW ALL 3 SHEETS Check # j} Date; Ila- Receipt# Staff, PARCEL INFORMATIO�-3 Tax Map and Parcel: (Existing Zonlig Parcel Owncr; Parcel Address: �1- � 'Ql1 fiN ilk City t✓VU UOP State VA- Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address; _2D3 W=bft"O�XVlr— City G��'bLi.i State VA. Zip U"LoP Offfcephone: (} Cell #��lax# &mail- GFt-04'va� ,G'© APPLICANT INFORMATION Cheek any that apply; . Change of ownership Change of use Change of name New business Business Name/Type; Previous Business on t Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of vehicles, and any additional information that you can provide; 6•--to WRV f- 2-'GIA PkLt -Ct"d *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, 1 hereby certify that I own or have the owner's permissi n to so the space indicated on this application, I also certify that the information provided Is true and accura to the best f y kno i . go. I ha re the conditions of approval, and I understand them, and that I will abide by them. Signature Printed APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved wlth conditions [ ) Denied [ } Baekilow 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 --t Date --t `k Zoning Official f Date / Other Official �✓!`�7 /1�� Date( �l 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 Page 2 of 3 Intake to complete the following: Y Is uOin LI, HI or PDIP zoning? If so; give applicant a Certified Engineer's Report (CER) packet. Y N ill there be food preparation? If so, give applicant a Health Department form. Zoning review can not gin unt'I w receive approval from Health Dept. FAX DATE Circle the one that applies` 4 Is parcel on private well public 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 appli�sewer? Is parcel on septic o p Y/N ill you be putting up a new sign of any kind? If so, obtain proper Sign permit., Permit # Y l�[F Wil ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Reviewer to complete the following: Square footage of Use: �b G �1 5' Y/N ermitted as: Under Section: Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Violations: v Y/N If so, List: Proffers: Y/N If so, List: —Z Variance: Y/N If so, List: CA r�(�( SP's: Y/N If so, List: Clearances: � � � � � SDP's IA WO-<o (A,-L-, —1 Wr C- Revised 7/1/2011 Page 3 of 3 b 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 [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] the owner of record of Tax Map by delivering a copy of the application in the 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]. Signature of Applicant Print Applicant Name ARM, Date Al Unary 00 37 mms AAffA - VQ 01 41-