HomeMy WebLinkAboutCLE201300102 Legacy Document 2013-05-16Application for Zoning Clearance -
OFFICE USE O
PLEASE REVIEW ALL 3 SHEETS
Check #�. Date:
Receipt # Staff.
PARCEL INFORMATJON ` 0 JJ
Tax Map and Parcel: 17- d a- 6 3 '+ O d 2,0 Z Z O Existing Zoning i 40
Parcel Owner: k d 6e g T 6 E s T; .-4zr
Parcel Address: ! L116 X)VC49 IU> flog CityC VIlle State (/ Zip
(include suite or floor) QQ
PRIMARY CONTACT
Ale.4+A0- e S. S,n
Who should we call/write concerning this project?
Address : 3 3/'5" fe -/Z%h9 $9 2 0 I . City e 1 y ll�e State 1/11? zip?-
Office Phone: l + /) 17f- G lL tcell # Fax # E -mail Yl S Al v c .. ,0
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
/''
Business Name /Type: B W i4 2 1,e Flo M/ d `0' Al k le-
12
Previous B siness on t e --
"Describe the proposed business including use, number of employ number of shifts, available parking spaces, number of
vehicles, nd any additional information that you can provide: .l�bG f o¢ S OFFIce-1 z e m p l6 v e C 5
12 2 N S .fce5
*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 o the best of i knowledge. I have read the conditions of approval, and Iffu__nderstand them, and that I will abide by them.
Signature Pruned 5 J to ()
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 ins_ pection 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 sir of 1 3
Zoning Official Date
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 N
Is us LI, I-II or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
y /
Will e be food preparation? '
If so, give applicant a Health Department forin.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one'that applies
Is parcel on private well o public `eater?
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
Is parcel on septic public sewer?
Y�
Wi ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y N
Wi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 1-5Z 1
6/N n
Permitted as: L-1f L41 01'1 i cJ�✓
Under Section: 2-0.11.
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
YN
If so� , ist:
A/ o ffers:
If so, List:
�y1G�
Vari ce:
Y/
If so, ist:
SP's:
/N
f 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, Zo K t n l C IC ARAtik ¢.
[Cofinty application name and number]
was provided to 44."7-
. n i G.'s!, TZV the owner of record of Tax Map
[name(s) of the record owners of the parcel]
« °° - Aa
and Parcel Number 6�p % Z • 0 3 ° ° ' Z a _Z by delivering a copy of the application in the
manner identified below: /�
r/ Hand delivering a copy of the application to TC O r G C 3 .r
[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 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 lof ApplicWht
HW(Q1r fin-
Print Applicant Name
Ca Ix I
Date q I
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