HomeMy WebLinkAboutCLE201200236 Legacy Document 2013-07-1701/08/2,013 04:39 9724310
#7971 P.001 /003
Application for Zonin Clearance
is
CLE # fE
-PLEASE REVIEW ALL 3 SHEETS
O FxICE USE ONLY
Check# '/ ?,0 Date; A7- r}�2o /-
receipt # Staff: Z /)A
.PARCEL INFORMATION
Tax Map and Parcel. Existing zoning
Parcel Owner:[�IU _
�i
Parcel Address; ZC56V lbSlT,#90 City6AK1,6TfPhUll- t'ttrtto Zips
(lbclude suite or floor)
PRIMARY CONTACT
,,//���
Who should we call /write concerning this project. f 4_SDF-qk1N FT"tP"t`-�
Address ;yf�iq6�;- CHICA+V%A - 2SIZ, City M State V Yom` zfp 2J
Office Phone: (_J Cell # 63 OAR # E- nanil�k'►th_tew. 159U��SQ�q
APPLICANT XNFOPMATION
Check any that a ply: Change of ownership Change oFuse Change of name New business
Business Name/Type: —rks'r p e' Zr
Previous Business on this site X1 %V 5 P e- P,
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicleg, and any additional information that you can provide: � -- '7 -►4-t� RiQ�l y�-
*This Clearnnoe will only b6 valid on the parcel for which it is approved. If you change, inronsify or move the use to a now location, a new Zoning
Clea.re.ace will be required.
I hereby oertify that l own or have the awner's parmission to us❑ tho•. pooe indicated on this application. I also certify that the information provided
is true and ace ofmy kno lodge. I have 'tad the conditions of approval, and I undorstand them, and that 1 will abide by them.
Llolst
0 Signatur Printed
APPROVAL INF&RAIATION
>9 Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backtlow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ) No physical site inspadtion 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 bAte
Zoning Official
Other Official r �� `�-- Date
UOUnty O[AlDemarte 1JeparEmenG of �,utnri,wti.r ur —Fir-1
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5632 Fftx: (434) 972 --4126
Revised 7/1/2011 Page 2 of
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01108/2:013 04:39 9724310
Intake to complete the following;
Y/b
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Mport (CER) packet,
/N
ill there 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 2 2 a
Circle the one that applies
Is parcel on private well or tc Wn 7
If private well, provide Heal ant fbrm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DAT E
Circle the one that applies
Is parcel on aeptle o� %. lic "o er
IY /N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit,
Permit # Z-W Z--:Z
7nnir,or to rntnnlato Oho fniinwina-
Reviewerto complete the following :.
Square footage of Use:
6 / N
Permitted as: iM-
Under Section :.A C . (i.
Supplementary regulations section:
Parking formula: i1-3 �
// b ()
RcgUired spaces:
Y/'
Items to be verified in the field:
Inspector : Date:
Notes:
#7971 P.002 /003
'Violations:
Y Oz)
If so list:
Proffers:
Tf so, List:
Variance:
Y/N
If so, LOO;
Y/
If so, ist:
Clearances:
SDP's
//— 17
12 3�
Rovised 7/1/2011 Page 3 of
01/08/2;013 04:39 9724310 #7971 P.003/003
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PRO'V'IDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupations, Zoning Clearance, Zoning
Ad►ninistraior Determinatlons orAppeals, Sign Permits, Bulleling Permits) if the application is not the
owner.
1 certify that notice of the application, _ -P45rL) RE zxvwop iA'N�" L
[County application name and number]
was provided to
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number 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
l/ 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 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],
ggnature of nt
Print Applicant Name
Date