HomeMy WebLinkAboutCLE201300141 Legacy Document 2013-07-05Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # �TgLrL Staff:
PARCEL INFORMATION 10�� i n ✓ n `y —0
'Map l�.P _L `-1• l.Jl
Tax and Parcel: Existing Zoning
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Parcel Owner: r.tG7
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Parcel Address: ��(Y c4d' ^ Fr City � V-• <<' State V / ( Zip zZ�a
(include suite or floor)
PRIMARY CONTACT r
MVho should we call /write concerning this project?
Address: �Y(�( SQtC�n•tu.. �l �J! / City `t/ i ((.2 State Zip
Office Phone: LN 'T I P (7 7? Cell # Fax # e0ee YoY4E -mail (,)Ob VA 64 r= c; a+ti a�
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ew business
Business Name /Type: ( Cn 1,4 J& S L (I
Previous Business on this site l/
Describe the proposed business including use number of employees, number of shifts, available parkins spaces, number of
C ( l
vehicles, and any additional information that you can provide: t9 to Se- t dvt Q ff' < t C m
*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 Zoninz
Clearance will be required.
I hereby certify that I ou-m of have the oumm-s pennission to use the space indicated on this application. I also certify that the information provided
is hue and accurate to the best of in owledge. I have read the conditions of approval and understand them, and that I gill abide by them,
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Signature li-- -- -� �—' Printed 96 h� r-,
APPROVAL INFORMATION
Approved as proposed [ ] Approved mrith conditions [ ]Denied
[ ] Bacldlow prevention device and /or current test data needed for this site. Contact ACSA, 9 77 -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 f t
Zoning Official „ Date
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 /DN
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y Ali
Wil 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 pter.
If private well, provide Hea ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic public sewe .
Y N
Wi u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y N
W re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to emmnlete the following:
Reviewer to complete the following:
Square footage of Use: 11D
)/N
Permitted as: � � `Z
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items be verified in the field:
Inspector : Date:
Notes:
Viol ons:
Y/I
If so, List:
Prof rs:
Y/N
Ifs 1st:
Varialce:
Y / /1V' l
If so, t:
SP's:
Y /
If so, ' t:
Clearances:
SDP'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 (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]
was provided to
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
by delivering a copy-of the application in the
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
[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
LA. V1
Print Applicant Name IJ
7.2'(�
Date
NOV -20 -02 93:04 PM WADEAPARTMENTS 804 293 9331
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CONTRACTOR TO VEWY 01MENSIONS AT SRE'AND NOTIFY ARCHITECT OF OISTAEPANCIES BEFORE PROCEEORIG I
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