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HomeMy WebLinkAboutCLE201300147 Legacy Document 2013-07-22�J NT �. _i ro Application for Zoning Clearance `4 CLE # 142 ., OFFICE USE PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt #. e I qr) 1 Staff: J PARCEL INFORMATION ' 1 Tax Map and Parcel: (a 0 O O — © D `� © ID ° ®� 5 O'a Existing Zoning m G) , i C Parcel Owner• �– s S CX CLSS® C i °` tz •fiat (3I � Qa`\4 Parcel Address: Zip (include suite or floor) PRIMARY CONTACT �. n h �' D Who should we call/write concerning this project ?.. Address • 1?1 a i w a I t h S T` City (V �_ State Zip 0.0 D Office Phone: a $ 16 D cell # q 3f .2 8 L/ , Fax # q 3'( 917 E -mail a60 X'a c o-SCr\ ex- Cc') rY- �. 0-t a-`7 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name. New, business Business Name/Type: G c- e N e x._, a Q CY 0_l S o �0--rl R Previous Business on this site h e U Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of v hicles; and any, additional information that you can provide: C v s (3 j -e- G-�^ fi-e t" y i L� S - �'-r -c�q�� •-. i �E1 cz .0 -e s . %�C. — �n a'a''�'� -� � C'it'�r� t� �O �-'i .Q..•@. S /'y O O Ctl,k � �"��'' .5' �O�.G..SL.S *This Clearance will only be valid on the parcel for whid it is approved. If you ch ge, intensify or mo e the use to a new location, .a new Zoning Clearance will be required. (Qr�tVU-?_ 0,J 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 acc5 to the best of y lrnowled e. I have rem the conditions of approval, and I understand them, and that I will. abide by them. Si ature /��� ✓� Printed Su AP OVAL 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. [�S]<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 -1 Zoning Official Date , Other Official Date County of Albemarle Department of Community vevelopment 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 )Fax: (434) 9724126 Revised 7/1/2011 Page 2 of 3 7 Intake to complete the following: Y /NN Is use m LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y/N Will 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 Circle the one that applies Is parcel on private well or Cublic�water�.If private well, provide Hea form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap 'es Is parcel on septic o public sewer Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / Will e be any new construction or renovations? If so, obtain the proper Permit. Permit # Toning to complete the followinLy: Reviewer to complete the following: Square footage of Use: 31 0 d o Permitted as: Under Section:`, Supplementary regulations section: Parking formula: D cn E Required spaces: n 0 Y/N Ite o be verified in the field: Inspector Notes: Violations: Y/N If so, List: Proffers: Y /N. If so, List: Variance:�'s: Y/N If so, List: (Y9N "'199 /S'o, List: r a y� a Clearances: l� SDP's �q ILI— q Revised 7/1/2011 Page 3 of 3 e �coL 9 o�- � � -3a � CERTIFICATION THAT NOTICE OF THE APPLICATION HAS SEEN 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 o the application, f GL "-, G c [County application name mbe an nu l-v �,e was provided to S �- SS oc 6 n S, L owner of record. of Tax Map [name(s) of the record owners of the parcel] and Parcel Number o(a © o6 V 'D o - d D - Q � 5 D qy 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 ( y m P- © m if- Y' 1 s e`C-&�-e!.+ 0-c- [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 y a t P, b to the following address: Date S, 0.r,\ [rtVtSf �N [address; written notice mailed to the owner at the last known address of the owner as shown on V F` the current real estate tax assessment books or current real estate tax assessment records satisfies aq 0 this requirement]. Signature of Applicant at -s A a. 6ae- Print Applicant Name -7 //3 Date n P n e 00 V� m �h n © 0 G v m OL CIO Vo � O \ I \ I I I ,rc) \ I � I I � I � I I o � r o r � CASENEX LY]1Y1 ! x n 2 r m A� y IMP CHARLOTTESVILLE i VIRGEgA N � N