HomeMy WebLinkAboutCLE201300087 Legacy Document 2013-05-20Application for Zoning Clearancerji''`
CLE # 2613 — 8
OFFICE US,ECMY 5� 1
UT CM
PLEASE REVIEW ALL 3 SHEETS
Checit #
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: C` 9? t)0 - 0 0- 00- 04134 0 Existing Zoning ^
-
Parcel Owner: W tJ % 144-
Parcel Address: Csty �.{�.�rLA -U- Ap- State V � Zip `2- AC)'L
(include suite or floor)
PRIMARY CONTACT
�Sh�
Who should we call/write concerning this project?
Address., N (280 `R•!Me4— n ,-,-h --C S1L City State \/A-• Zip2 : -
Office Phone: 4(3 q-62 ILGO Cell #, q(pO-6001 Fax# E -mail ClntyGC� �hieuScPt' nncr
APPLICANT INFORMATION
Check any that apply: _Change of ownership Change of use Change of name •X New business
Business Nnme/Type: So_kI i A grzn motAc - -R>b ek -skz�,,e Gx�
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, nvailable parking spaces, number of
vehicles, and any additional information that you can provide: fzxr� Vr�Oc t e C � t 2tvt (�QS\np�S�
f.�.t��G� S �utc•�_� � det�Cl,� -- - -
*This Clearance will only be valid on the parcel for which it is approved. Ifyou 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 me best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed_ jN<Vvu�
APPROVAL INFORMATION
Approved as proposed [ J Approved with conditions ( J Denied
[ ) Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xI17.
[ ] 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 ofth s date.
Notes:
f
Building Official Data y 1 ( t
/
Zoning Official l Date
Other Offcia] Date 15 % �3 0V.
County oc Aldemarle treparrmenr or t.ommunuy 1rGrtlivt)lilGnL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised V1 12011 Pgge 2 of
Intake to complete the following:
Y Bi Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
i�f - re be food preparation?
If so, give applicant a Health Department form.
Zoning review can nobgi.n un it w receive appro�vval fin in Health
Dept. FAX DATE j(
Circle the on at es
Is parcel o private wel or public water?
If private we , provi e ealth Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the nseptie pplies
Is parcel o r publ ic sewer?
Y N
Vill you be putting up a new sign of any kind? If so, obtain proper
Sign permit. -
Permit # CJ
Y /0Wil ere be any new construction or renovations?
If so, obtain the "r per Permit.
Permit #
7.nnina to emmplPtP the following:
Reviewer to complete the following:
Square footage of Use: To J
9 / N
ermitted as: AlbAj io �'
Under Section: /o, 2 -� [
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Item o be verified in the field:
Inspector : Date:
Notes:
_Viola,t�* ►
Y /l'
If so, List:
Proffers:
If sOQ'ist:
Variance:
Y/ (�
If sKist:
SP'
Y N
If so, ist:
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,
was provided to
W. )CC
Zo �J , c.c.s -c"s
[County application name and number]
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number 0q? co — M- oo - 04Sr -0 by delivering a copy of the application in the
manner identified below:
�j Hand delivering a copy of the application to [Name of 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 J5 11 III
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 of plicant
Print Applicant Name
Date