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Home My WebLink AboutCLE201300130 Legacy Document 2013-06-19Application for Zoning Clearance 2� = °� ��''r- CLE # �� ` 1Y �. .�l)� r OFFICE US ON %Y 121 D Date: ' �3 PLEASE REVIEW ALL 3 SHEETS Check # Receipt # CJ115h4 Staff- PARCEL INFORMATION yJ Tax Map and Parcel: O -d U Existing Zoning Parcel Owner: Parcel Address: /�� -� rZi��^'S &VjCity VA Zip 2210( (include suite or floor) PRIMARY CONTACT this Who should we call/write concerning project? Address : 8 ZS t?(� L/'3 City CH,q C-La 7�-S"�"itate V14 Zip 2_2 `30 1 1 T 73-�?E -mail i 4o, Z� f' �' n �� C�✓`� Office Phone: 3f1 73°/ Cell # %1,76 Fax # �� APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: Z f -Pr - ^ -t— C o d,- Y/ N C, 5 / 4"1 S 6- �t4NN�itJ' 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: .s ` 3 Z ej,.yra 1�avN its NG+� Se�aiCam?_. *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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed vyia %may - Z✓yl.�i2�i� 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 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 C, Sr t Zoning Official Date 6;11.9 � 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 fi Is LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y�Wil 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 public water? If private well, provide Hea ep ent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies /Isspparcel on septic . public sewer? /Y / N Reviewer to complete the following: / Square footage of Use: / i UD (?)/ N // n Permitted as: 4-- ''y2 2 ii Under Section: I Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: 'Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. , Inspector Permit # �' I V'u `Y /N N ill there be any new construction or renovations? If so, obtain the proper Pe Permit # Zoning to complete the following: Notes: Date: Viola.� ns: Y/ l If so, List: Proffers: Y /(-N) If so', 1�ist: Variance: b/N If so, List: SP's: Y/N If so, List: Clearances: SDP's / 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 (Horne Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeaft, Sign Permits, Building Permits) if the application is not the owner. f certify that notice of the application. Z' 01� - 611 ! z ^ " [County application name and number] was provided to S Gega,5 Qsjheeoowner of record of Tax Map [name (s) of the record owners of tfiepare,611 and Parcel Number Oq 500 -00 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 X Mailing a copy of the application to 6.c.4`, 6,jenS [Name of the record owner if the recd d owu r is a pers ; 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 �) , -2--013 to the following address: Date C- cs��- �� ( goo a o `4, VjT 537,1' [address; written notice mailed to the owner at the last known address of the owner as it 'wn or the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signature of Applicant Print Applicant Name Date rn rn I no 11 1 . V I C . c O=p= m 4- C: 0 LL.