HomeMy WebLinkAboutCLE201300134 Legacy Document 2013-07-03rf
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Application for Zoning Clearance
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CLE
OFFICE US + )N Y
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Staff:
Receipt #
PARCEL INFORMATION ,/
Tax Map and Parcel: 0 SS 6 0 " 0 0'- 00 °- 6 I (a A-0 Existing Zoning /-t-� Cornv�t -Yt i r i
Parcel Owner:
Parcel Address:60�� k0JL6-5kg,D 1yr'n 1L City C_V',,) 2e f State Zip7 7-1 3Q
(include suite or fl or)
PRIMARY CONTACT[ (�
1 ) ` 1 �-O"�
Who should we call /write concerning this project?
l
Address : 8' ,i7X �� City �% State v Zip�S�S
Office Phone: 3� �f ' 0 Cell # Fax # E -mail ) Ing&
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
�C1 ' [
Business Name /Type: ox r 1 � O�.k]C'_ � � 00. \ _ S �c+ V\
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, any additional information that you can provide: orcti I( e_e M'(- oLm _ to yes.
((and
e- ..S N (r4 f S e S v,vri e- GLre- a, (' oZl i`f C� ✓1.� -1 �' CtC�S e'_
e-.
*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 est of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
I 'ut
Signature Printed
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] B ckflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[o 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
7t,::::_
t
Zoning Official Date
Other Official Date
County of Albemarle Department of Community veveioprneni
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:
Is
Is us to LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y `rti
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 p�epartment
If private well, provide Hea form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applie
Is parcel on septic QrDublic sewer?
Reviewer to complete the following:
Square footage of Use: 0" 1. M �A
D I it mitted as:
Under Section: 1-C- d • 1•
Supplementary regulations section:
Parking formula;
Required spaces:
YAM Ite be verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permi .
Permit # Inspector
I, xlr,� Notes:
Wil re be any new construction or,renovations?
If obtain
Perr mit # � ^�
7nninv to emmplete the followinu:
Date:
Vio t s:
If so, ist:
I
Proffers:
Y/
If so, ist:
Van ce:
Y /IN�
If so, ist:
SP's:
Y/n
If so t:
Clearances: ,ylr-"f I
SDP's
Revised 7/1/2011 Page 3 of 3
Analytics Online
Page 1 of 1
Print Date: 06/19/2013
Image Date:04 /01/2010
Level: Neighborhood
http: / /picto. albemarle .org /efs /php /prhat.php ?ti.tle= &date fmt =m/d /Y &year= 2010 &month =... 6/19/2013
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,
[County application name and number] � j „r�l
1(�
was provided to fl W 8A 1r (&I the owner of record of Tax Map
[name(s) of the re ord owne s of the parcel]
and Parcel Number '— /)A— by delivering a copy of the application in the
manner identified below:,
Hand delivering a cop f the application to
P*Xm'—e of the record owner if the record owner is a
person; if the owner of record i enti , dentify the recipient of the record and the recipient's
title or office for that entity]
on
Date
YANCEY, RICHARD A JR, E D B YANCEY &
Mailing a copy of the application to _ RAY 11 LLC
111 STURBRIDGE RD CHARLOTTESVILLE VA, Zer is a person;
if the owner of record is an entity, id 22901 dent's title or
office for that entity]
on to the following address:
Date
[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].
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Date N