HomeMy WebLinkAboutCLE201300139 Legacy Document 2013-07-29(?yin nUl 4
Application for Zonijgy Clearance
CLE #
OFFICE uE oNL Y F ,
Check # bete:
PLEASE REVIEW ALL 3 SHEETS
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Receipt # Staff:
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PARCEL INFORMATION
Tag Map and Parcel: Q2,2CD— C0-0Q-C j3W Existing Zoning PPMC.
Parcel Owner:_ Cok rnbict 1E �--`l� �V VYlfC2C�� L—LC_
ParcelAddress:22-5 (bmyy\uKs:W (St Cityc, yloi s l I State VA Zip 2—,-P I1
(include suite or floor)
PRIMARY CONTACT
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Who should we call/�vrite concerning this project? Y I LI p!) I Gb
Address : -Mio 11c(AYwA) Dr 2--63C CityCkuf lci-i6gi Ike state% /-\ zip 22-90 )
Office Phone: 634 gSZ' 4-,172 Ceii # Fax # E-mail Vi&i VuWi k4 Q 'i kUVY1 & (om
APPLICANT INFORMATION
Check any that apply. Change of ownership Change Change of use Change of name business
Business Name /Type: V1 Amoy) 1�1 °� Kf7�(il l�l[1 C�°.i it r ar OME l.0-'�y i I Le
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Previous Business on this site &,, �ks Too-fan
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: After school lenroirn cent +ei2.x wc-cL,,nc -RK
Ohcc i .'; LA�Y\ �� S�ICLZI I'IOIAYS I D l7 'Q-r-!
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*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 oum or have die oivnees pennission 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.
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Signature Printed YIh�C i Il�`Jh IG�CI
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved v�ritli conditions [ .] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -411, x117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance vaith the existing
site plan.
[ ] This site complies -,arith the site plan as of this date.
Notes:
Building Official Date `�1 t:4
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottes -Zlle, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Yl
Is us n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Yl�Will sere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin tuitil we receive approval fiom Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private we o ter?
If private well, provide ea n epartment form.
Zoning review can not begun tmtil we receive approval fiom Health
Dept. FAX DATE
Circle the one that appl'
Is parcel on septic o r lic. er?
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: AUy
6/ N
Permitted as: G CZ
Under Section: .q. Z - )
Supplementary regulations section:
Parking formula, p
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
I'N
so, List:
Proffers:
(2) / N
If so, List: /J
Variance:
I N
f so, List: ( 6 r
l
Y I N
so, List:
G 7 ��
Clearances:
SDP's s,
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Revised 7/1/2011 Page 3 of 3
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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, A ip � % %cah6; 7 A i/ 2om ii? (�I ,,a/,-a%me-
[County application nanle and number]
was provided to ('(;ri i j�yi �jl(,i N�ll�l v�rrr�i Z_LL the owner of record of Tax Map
[name(s) of the record o lers of the parcel]
and Parcel Ntnnber y 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]
oil (2A [ /
Date
_Mailing a copy of the application to _. �GL�C.. '. V (� I en j� .ory— na 1,���" i'S
[Name of the rec e Ucord Amer 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
Colt Y [ 3 to the following address:
Dat6
12eap w CgkAs M IbWS Qed , �ifc 1000 �ccin q , y A 2,2-)TL
[ad" -s; writlen notice mailed to the owner at the a^ swrl address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signatt -e of Applic nt
Print Applicant Name
Date