HomeMy WebLinkAboutCLE201300049 Legacy Document 2013-07-01H
Application for Zoning Clearance
0
OFFICE USE ONLY
104411
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION -
Tax Map and Parcel: 0 (n 100 ` 00 - 00 LA 0 Existing Zoning�c� I Gkn h1t rr_ Q
j0
L-, L
Parcel Owner:_ws C-1
Parcel Address: 1lo4k" Sex►-, kr+ol.Q -T X4.1 CityC.h4>ll okegy"�)1 -e. State VA Zip.,12g0
(include suite or floor)
PRIMARY CONTACT n _ 1 '"
Who should we call /write concerning this project? OQW In WQ 1 I . Q -Q 1 E S+G }� --'nD2
Address :is &) t S4 <e.& Isle . ;2 Q City VQn nQh State �� V1 Zip31y0 I
Office Phone: ftla 21 -5453 Cell # h Fax A,(a E -mail (AQWrn.WCj 11 (� .
fN q
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
`
Business Name /Type: T \ n � ej'i1 Q _g O t' y �Y�L: h i � T I- c . An4-i'O K yL.kr J-e -1;, 2 Le-n e r
,
Previous Business on this site VO LQ n n \\ n t, C' •,Q 4 CA
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: .9 e. '
Or- I=f -'� 54 ! O
1 L i S
*This Uearance wilronlylbe 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.
DJ
Signature Q/wr) In � Printed 1JQwn WL111
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 f Date
Zoning Official '� r Date /Z rhV3
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/0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will ere 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 o ublic wat
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap ' s
Is parcel on septi or public sewer9
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign perm't
Permit # fi
Y/N
Will there be any new construction or renovations?
If so, obta t e,p , er rmit.,.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: ./U
O/ N
Permitted as: cei
Under Section: �t9, Z • %
Supplementary regulations section:
Parking formula: l
Zo a Nom'
Required spaces: j
N
tems to be verified in the field:
Inspector : Date:
Notes:
Violations:
,V/N
If so, List:
/� n
Proff /rp:
Y /&/
If so, List:
Variance:
O/N
If so, List:
L/
SP's:
Y/N7
If so, List:
Clearances:
SDP's
U.3 ---73
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 App_ eals, Sign Permits, Building_ Permits) if the application is not the
owner.
I certify that notice of the application, (4j he-M Q(j C C0-44 ,i
[County application name and number]
was provided to WS ('1 the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number d p 100 - 00 - 00 - QVl 0 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 Lo,/ 4 0 La�dd % , LQnol I(J(,,d i-5
[Name of the record owner if the record owner is a p on;
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 3 to the following address:
Date
Gol V t CS rrn-k lna-�;a,Q I . late w. [(caot 7 L S4e .LIQQ , Nkc lviOnd , v (4 3z3a
[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].
D ann3 n VQ CA
Signature of Applicant
D0,Wn W01\1
Print Applicant Name
3kal13
Date