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HomeMy WebLinkAboutCLE201200247 Legacy Document 2013-07-17Application for Zoning Clearance � CLE (t 9le PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # 7 Date: �' `��yy v " 1,6 Receipt # ° l Staff: PARCEL INFORMATION �,% r� GI p Tax Map and Parcel: Existing Zoning !'" /�/' UL Parcel Owner: 1 ilk' Parcel Address: l l� a► I LLD ft City ` w-4e State VA Zip P0 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? eJ�f Cr2 V�l(��(� (S(UvG9JAk' � fQAA of C''S Address: IA �p k �—fOM fd 1 S1 42 a55 City 20m=s State yV Zip D105 QC Office Phone: QL5'_j C i9A j Cell # Fax #x`13 'aS_') g9)A0 E -mail �15a APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: �—niu 6_ 00up CtE) ON1� t �C� ww) Previous Business on this site 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: �A—P&FgV4-AQ . CA " ID F rJl 040-, r) Sh1 &S *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 best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature 00,�— W 0,—, Printed T-y--Si(Y'L CO- bs-r .v\ 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 Date 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 /(31 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y 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 or ublic wat If private well, provide Health apartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or lic sewer. 'Y) / N ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # 0 N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Y� �Yti Zoning to comDlete the following: Reviewer to complete the following: Square footage of Use: ! D VIN Permitted as: rc,A,' Under Section: Supplementary regulations section: Parking formula: � /Jod Required spaces: Y ItemHo be verified in the field: Inspector : Date: Notes: Viola ions: Y /oN If so, List: Proffers: /N Of so, List: y— 2a Variance: d/N If so, List: SP's: Y/N If so, List: Clearances: SDP's (�z-yl 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, W V 4 �4 UI [County app ical tion name and number] was provided to�C ll}}�Qt,� �r ©P�s k 1QS, the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number manner identified below: 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 K Mailing a copy of the application toSQ [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 �1 I ) ,�) l ) A to the following address: Date [address; written notice mailed to the owher 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]. Lj�,uj9--, Signature of Applicant 'TxQ, m2 1 /Uxc,.,-JA Print Applicant Name X11» Ili Date,