HomeMy WebLinkAboutCLE201300133 Legacy Document 2013-06-26--V N' hn -Ojr W rMn5
Application for Zonl Clearance�1z4'`
PLEASE REVIEW ALL 3 SHEETS
OFFICE US 1 ONLY
Check # VC> I Date: "J
Staff:
Receipt #
PARCEL INFORMAT� j J�
Tax Map and Parcel: ' 1 ' W Existing Zoning �.
Parcel Owner: 1 UJ(b6 l.t yd l ` LO-,
nc�
Parcel Address: Wo A'amart � City f yeJO I1C, _ State T't zip `�q
(include suite or floor)
PRIMARY CONTACT / /
�t
Who should we call /write concerning this project? (�i]-P.rnUmb✓1
n
Address: N)o Kid ,-Man Pd &.; oLol City CA W/01fo w4 State V /-r Zip ��
Office Phone: ( 1 a?2, gfly Cell # Fax # E -mail
C 6l da 9A 03 a-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ew business
Business Name /Type: l2 L �� lr
Previous Business on this site l'S Z. I �/`V ` `�'� �:f�/�.
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: _ %r PCc[ 00—(e kv
*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 st of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed ( � V� Y11 fA 2r av
AP�UOVAL INFORMATION
[ ppro d'as proposed [ ] Approved with conditions [ ] Denied
[ ] ow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[' site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
eophysical
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date a-? t 3
Zoning Official Date (4 �V_ 1 1 3
Other Official Date
County of Albemarle 1leparLmeni of %- ouuuuniLy l t;VV1UF11LVJ1&
401 McLitire.Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
02o•^.
Intake to complete the following:
Y N
Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
W-h,A here 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 wat er? If private well, provide Hartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic public sewer?
Y N
Wi ou be putting up a new sign of any kind? If so, obtain proper
Sign ermit.
Permit #
Y/N
ill there be any new construction,or renovations?
If obt n the prp�P
Permit # rmit. �- ^ / — 6
r/. .. +n nnmr.ln +o +ho fnllnwina-
Reviewer to complete the following: L
Square footage of Use: �a►J`""(
a
N
rtted as: �»
mi n
Under Section:
Supplementary regulations section:
o a�
Parking formula: 6D n- .0—
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes: WIL11112,
uu as aaa
Violations:
Y/N
If so, List:
Pro ers:
'Y /IN
Ztrso, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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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
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner ' ratified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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
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 Applicant
Print Applicant Name
Date