HomeMy WebLinkAboutCLE201300096 Legacy Document 2013-05-20TV
Application for Zoning Clearance
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CLE # 061-3 -17-K
PLEASE RENIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# 1401
Receipt # el ( — Stan.. > "!
PARCEL INFORMA71ON
Tax Map and Parcel: L 3 (.4 — OL) , 0' O 1 000 Existing 7..onin� b
Parcel Owner:
Parcel Address: { �1 �,r�,•t• h N I, City C�A'' ,,.I L, State Uli Zip'ZZ- I.
(include suite or floor)
PREVIARY CONTACT
S 1" cc CA
Who should we call/write concerning this project?
Address: I'LL City iS�L+ &,A— State Us zip
Office Phone: {` cl'l'1 3 o t Cell # _ R Lo- 5-721a Fix # E-mail
APPLICANT Ilti- "ORIlZA.TION
Check any that apply: Change of ownership Change of use Change of name X business
rNew
Business NamelType: 1 4 �,"1 '^ (_An
-C�./1
Previous Business on this site
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:
*This Clearance will only be valid on the parcel far 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 nwmes's permission to use the space indicated on this application. I also certify that the information provided
best lmowledge.:I. have read the conditions of approval, and I understand them, and that 1 vdl abide by them
is true and accurst a ofmy
Signature Printed
APPROVAL INFORMATION Denied
-with conditions [
X Approved as proposed [ j Approved w i3
[ ] Backdow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
[ ]No physical site
site plan.
[ 1 This site complies with the site plan as of this date.
Notes*
Building Official Date �� t
Official Date
Zoning
t
Date ��w��+✓' i
t" ' _ r. __ _._, •... ..a ..r !',...,,,,,,.,;tu r)r.vnl nnrnent
% -uuuap u1 talu,;r -... ,..,.p,.....,._.» _. _ _ ----- w
401 McIntire Road Charl6ttesville,''4a'A 222902 Voice: (434) 296 -5832 Fax, (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
F intake to complete the following:
Reviewer to complete the fallowing:
Y /
Square footage of Use:
Is use in L1, HI or PDTP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
N
lermitted
Y l
as: -'%c4l .�A�, 5
j,
Williere be food preparation?
Under Section: AP/11 J��'
If so, give applicant a Health Department form.
Qz,
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the one that applE�rt'
Parking formula:
Is parcel on private weter?
If private well, provide ent form.
Zonin g review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
Y/1
Circle the one that
Items to be verified in the field:
Is parcel on septic orf ubtic sew ?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector: Date: i
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit:
Permit #
Zoning to comnlete the fallowinu:
Violations.._
Y/
Ifso,L.ist:
Proff rs:
Y1
'Ifso, ist:
Variance:
YI&
If so, List:
( /N
If so, List:
Qz,
Clearances:
SDI" s
E.
Revised 7/1/2011 Page 3 of3
L
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This farm must accompany zoning applications Olome 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, 1
[Coutnty licationname and number]
was provided to r, in the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number O'-lin 13y - 00 '4-NL u i0� 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; 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 '1r _. -
[Name of the record owner if the record owners 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 5- ] to the following address:
Date
[address; written notice mailed to the owner at tlxe last lmown 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
9-S-(,3
Date
0
1.0
Rebecca Morris - Fire Rescue
From: Shawn Maddox
Sent: Wednesday, May 15, 2013 5:23 PIVI
To: Rebecca Morris - Fire Rescue
Subject: RE: your approval for 3 clearances is needed
All three are approved since they are to be permitted by our office.
Shawn
From: Rebecca Morris - Fire Rescue
Sent: Wed 5/15/2013 11:54 AM
To: Shawn Maddox
Subject: your approval for 3 clearances is needed
FM Maddox,
Please approve/disapprove and comment regarding attached the 3 Zoning Clearance Applications by way of email to me. I will
sign and attach your response to the application and return it to Community Development in your absence.
As information, I've already spoken with Linda. Shifflett as well. We've scheduled her Fireworks Retail Permit (inspection) with you
for 0612712013 at 1 PM beginning first at 260 Pantops Center, followed by the two locations on Seminole Trail. She's going to
submit to us the usual paperwork as soon as it's completed (property owner permission, list of fireworks to be sold, copy of
insurance). She's had the same permits at these locations for the past several years. She is using a pop-up canopy, not a tent.
Thank you,
Rebecca Morris
Fire Rescue .Department
Extension 3101