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HomeMy WebLinkAboutCLE201300152 Legacy Document 2013-07-29Application for Zoning Clearance OFFICE US�QI�JLY t� `2V (�J�ipp PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # tA 1603 D Staff: PARCEL INFORMATION j1' .., 4! I ._mrn� '� `� 11'1 Existing Zoning t (lJJ6 (i Tax Map and Parcel: g 1 Val Parcel Owner: ''''\\��p�^ i 1 ' M w IUF City C- e `� y`�\� tate Zippk)'R CA Parcel Address:. include suite or floor) PRIMARY CONTACT —� Who should we call /write concerning this project? a�'e Address : LA � � R VCA« %f�n� PA City ©! � �`"�State Sal (� •- @f€ise.Phone: (___)��(3 6 Cell # 4C79- I \al\o Fax # E -mail 1uC VW lAA) APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name =New business Business Name /Type: = )�,y ` L 1 L Previous Business on this site �oV yjy)S 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:. •cr \ k S ac-2 e L `� ", 1 S J . l -A, f� . *This Clearance will onl be valid o he earcel 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 ha e read the conditions of approval, and I understand them, and that I will abide by them. Signature -- Printed �sC ;; :D;z � -P APP OVAL INFORMATION [r�ppr /ed as proposed [ ] Approved with conditions [ ]Denied [ ] B eRflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117. [Li] 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 C Date f ss� Z Zoning Official V11 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 pki \PO z,S w, Intake to complete the following: Y/N Is us LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. QJ/ 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 14.3 k& +b Circle the one that applies vW51 Is parcel on private well o public water? If private well, provide 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 septic o public sewer? YV/ N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit, Permit #��J Y N Will there be any new construction or renovations? If so, obtain the proper ermit. Permit # i r7.. .. i- ..ln +a +ha fn1inwina- Reviewer to complete the following: Square footage of Use: q" 0 Y rmitted as: Under Section: nl 4 0 lA. Supplementary regulations section: Parking formula: Required spaces: Y/ Item - e verified in the field: Inspector: Notes: (JVll111 I.V VV111 1V4V Violns: Nj Po f Y / , s),List: If sot: riance: /N it so, List: la 1,tA 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 or Appeals, Sign Permits, Building Permits) if the application is not tlae owner. I certify that notice of the application, [County application name and number] was provided to the owner of record of Tax Map [name(s) of the record owners of the parcel] 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 Mailing a copy of the application to L`cr A. ,- U 0.V,-e- C- ' � P [Name of the record owner if tl e 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 01 to the following address: Vk a [address; Oritten 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]. i natu of Applicant y�-skt-"a Wov�-V--- Print Applicant Name X -1�l I � Date \IVY V:4--o ot- + o •J Y( t�. �� ^� +:tip. � x, 5- s+ Applications for Zoni d 19 'earanceI� ` a CL E- 1 � � OZ. k,, OFFICE USI?t SP Y t r. ! 2- PLEASE REVIEW ALL 3 SHEETS Check# tQQ((pp Date: Receipt # Staff : .y PARCEL INFORMA I N �� '� `2� Existing Zoning, Tax Map nrid Parcel: )7 i �i Parcel Owner: �1tZ 1�1(SYlii) �� Iit C4���\�v`�state� Zigof Y Parcel Address :. include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? �� 'eye Address : q0 �yctC (�f Cl L6.) 1 �-t =honc�� Sit`(G Ce1 # ^L d7 - l oo Fax# Email,� W Al� 5m '�17, cc5 APPLICANT INFORMATION Cheelc any that apply: Change of ownersllip Citange of use1 Change of name New business Business Name/Type: Previous Business on this site i� �7i�S � ry'ICA -/3 Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional Information that you c n pride; .� Cry t 4c �` �' c7 c_ a Z �F 15 is L t CA "This Clearance will onl be valid on4he 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 ha a read the conditions of approval, and I understand them, and that I will abide by them. Signature _ Printed APPROVAL INFORMATION [ J Approved as proposed [ ] Approved with conditions C ] Denied ( j Backtlow prevention device and/or current test data needed for this site, Contact ACSA, 977 -4511, x117, [ j No physical site inspection has been done for this clearance, Therefore, it is not a determination of compliance with the existing site plan. [ j This site complies with tare site plan as of this date, Notes: Building Official. Date_ Zoning Official Date t Other Official Date r.;oun[y or aloeiminu lityau uucn� .,.. 4tol Nlclntire Road Charlottesville, VA 22902 Voice: (434) 296- 58321inx: (434) 972 -4125 Revised 7!1/2011 Page 2 of 3 ;S a