HomeMy WebLinkAboutCLE201300089 Legacy Document 2013-05-06Application for Zoning Clearance
CLE #1015 - N
PLEASE REVIEW ALL 3 SHEETS
OFFICE USJE ONLY
Check # Date:rJ 2 13
Receipt # 1 Staff: yYn I
PARCEL INFORMATION
Tax Map and Parcel: 55E '" u Existing Zoning
Parcel Owner: l(t,r'lil d 1 U I Utf kIN G 1 W V f4) L—LO-1
—MM
Parcel Address: 1005 c -Gk/e Y�Z� City C'q'b2iE-i' State J� Zip ZZ9
(include suite or floor)
PRIMARY CONTACT �%
Who should we call /write concerning this project? f -C v la LLC-F-o+ -a
Address `4A-t4 (Lo City CA,- -1, CT State U+ Zip 7z-
Office Phone: Cell # go 4.3$ 7.2*3 Fax # E -mail Ct_ (Fyo 4,0 1c — MR �� •c� "'
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: l— (t o 2 c' it �� Pri Mc� �G^'15Tt2i
Previous Business on this situ
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: Nb� emu. )E� N TAI, O fl,". g " to Ff4 PI-01 er.5 .
5-0 a "Lt c'.N
*Thus 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 o ees permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of :Lny.Ydfowledge. I have read the conditions of approval, and I understand them, and that I will abide by their.
Signature Printed 4vr-/ �i�Fb2I�
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Back1low 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 3 t
Zoning Official Date S� �,Zo> 3
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 Page 2 of 3
Intake to complete- the - following:- -- - - - --
Y /0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y '
Will sere 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 r ublic water
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 ap he
Is parcel on septic publi�sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign p
Permit # l�n 1 ��
YY N
gill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # l i`1 QJ
Zoning to complete the following:
Square footage of Use:
6/N
Permitted as:
Under Section: O/L J
Supplementary regulations section:
Parking formula:
7 5 it
Required spaces:
Y/N
Items to be verified in the field:
Inspector•
Notes:
Date:
Violations:
Y/
If so, ist:
Proffers:
/N
If so, List:
Vari ce:
Y/
If so, ist:
SP's-
Y/(
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 orAppeals, 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 Mq.2c14 sA •JTo" J pn - PgAzr -s the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
Hand delivering a copy of the application to 6c:iA t v l n-j ^' i or%A ��,o , cn ,1 , UL
[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 s- Z.. _
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].
Signature XApplicant jJ
Print Applicant Name
j 2
Date
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