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HomeMy WebLinkAboutCLE201300082 Legacy Document 2013-05-09OFFICE USE ONLY - Zoning_Clearance.pdf http:// www.albemarle.org/upload/images /forms center /departments /C... 2 of 4 Application for Zoning Clearance CLE # §nIAJ4 J ' PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY r l Check# Date:` Receipt # Staff: PARCEL FUORMATION Tax Map and Parcel: DS IPnn - 0 lD U _Existing Zoning jDO Parcel Owner: C�u�� he�. Parcel Address: I �U �/� � ��� ' City C"1,4 State VA Zip 1'J (include suite or floor) PRIMARY CON TACT concerning this project? f�Ul Who shouldi w /e-��call/write ��j ' PAW. Address: { �U U C1Vou_k City D State V / 6 Zip Office Phone: C�* # Fax# E -mail racq ��(�Iiil%• Vl APPLICANT INFORMATION Check any that apply: Change of ownership Chang e of use Change of name New business Business Name/Type: JV► 00I &f (%c /1 '"o qe6 UI I (V Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parldng spaces, number of vehicles, and any a ditional,information thatyou can provide: IV Ew ��i , C'b d U W1 ` l , yw'd vL - E�tti 5� o rl'1 o _ _ *This Clearance will only be valid on the parcel for which it is approved. If you than =e, 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 of -,per'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 krowled e. I have read the conditions of approval, and I understand them, and that will abide by them. Cam/ afar /l Printed Y Cam/ IKuril�G APPROVAL IlVFORMATION 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 C-4 �f Zoning Official Date Other Official Date County of Albemarle Department of Community ueveropm en t 401 McIntire Road Charlottesville, VA22902 Voice: (434) 196 -5832 Fax: (434) 9724126 Revised 7/1/2011 Page 2 of 3 4/15/2013 11:421 OFFICE USE ONLY - Zoning_Clearance.pdf Intake to complete the following: ID Is Y u N J LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. gill there 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 p blic water If private well, provide Heal par ent 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 blic sewer? Y tiTJi you be putting up a n sign of any kind? If so, obtain proper Sign permit. Permit # Y `'Vi ere be any ne ustruction or renovations? If so, obtain the oper Permit. Permit # 7nninrr to i- mminlafp the fnllnwin0'_ http: / /www.albemarle. org/upload/ images /forms_center /departments /C... Reviewer to complete the following: Square footage of Use: )q6UYA Pei/M:tedas:�� Under Section: Supplementary r bulations section: � _ u�a�l ��anS Parkins formula: Required spaces: �� _ AXAJ, r. -1 A Y / N Ili Items to be verified in the field: Inspector Notes: Date. uvuau- Viola ' s: Y/ If so, st: Pro er Y� - N If s , ist: Variance: Y / N If so, List: `Y N so, List: L'1 L CIearances: AM- U - Q6 KSA SDP's Revised 7/1/2011 Page 3 of 3 3 of4 4/15/2013 11:42 AM r VYII, rvo),a y saV)) ofv i 4� o� V' Q � 54 d.. n A 3 -/I- 12X q� � Eu; OFFICE USE ONLY - Zoning_Clearance.pdf http:// www.albemarle.org/upload/images /forms center /departments /C... I 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, �Ont,rq (?� i 0-(CAIYI U-1 [County plication name and number] was provided to �I�t vt, h vttlb the owner of record of Tax Map [name(s) of the rk-orctowners of the parcel] and Parcel Number ©D 5[o D 6 - 06 -0 0 -6(p2X by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to [Name of the record owner if the record owner is a. person; i f the owner of record is an entity, identify the recipi ent of the record and the recipient's title or office for that entity] on Date Mailing a copy of the application to t� [Name of the record owner if the record owner is a person; [N P 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 41 �L3 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]. Print Applicant Name a3 ,y C?03 Date 4 of 4 4/15/2013 11:42 AM