HomeMy WebLinkAboutCLE201300158 Legacy Document 2013-07-29irk
Application for Zoning Clearance
CLE # _b � r 1
OFFICE U E
PLEASE REVIEW ALL 3 SHEETS Check# Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: /j0 ?$ 00 — 00 — 00 _ 00760 Existing Zoning H C
Parcel Owner:
Parcel Address:
121"S-</, %l State tJ/f Zip l -711
(include suite or floor)
PRIMARY CONTACT n
Who should we call/write concerning this project?
Address : �(� G�i ���1 ��C�C C;ty l af�� tate
Office Phone: /' I ���C'ell 4 82 E -mail
APPLICANT INFORMATION
Check any that apply: _ Change of ownership Change of use _Change of name New business
Business Name/Type: AN G &!E,
Previous Business on this site 1j 1 file
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: /z;✓ G: h,- /e
*This Clearance will only be valid on the parcel for which it is approved. Ifyou 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 certiiv 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 Printedjt
APPROVAL IlYFORlYIATION
J;Pq 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.
Building Official Date -1
Zoning Official Date _ , ! 1,,X i
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Face (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
d
Intake to complete the following:
Is usLI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will t 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 "ter?
If private well, provide�Heal epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic . jQ
Y/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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
/N
ermitted as: AA,46g!, : �Ln�t"le� 54
Under Section: 2Z y. 2. 1
Supplementary regulations section:
Parking formula: ,
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
6) /N
it so, List:
SP's:
Y/N
If so, List:
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 orAppeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, i 41(6tf Coro]
D /J [County application name and number]
was provided to , `� /� /' �'�Z �� S� �,/.) the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 0'78 00 — o o — 4o- ad ?0G by delivering a copy of the application in the
manner identified below:
X Hand delivering a copy of the application to __ A2-b PAA+ mm-L�0
[Name of the record owner if tfie 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 `7
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:
laaaress; 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].
E7�
Signature of Applicant
G e�- X-�.
Print Applicant Name >�
-7- /9-/
Date