HomeMy WebLinkAboutCLE201300160 Legacy Document 2013-07-29NA mu
Application for Zoning Clearance
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OFFICE USE ONLY y 1
PLEASE REVIEW ALL 3 SHEETS
Check # Date: J
Receipt # Staff:
PARCEL INFORMATION (,
Tax Map and Parcel: `�5�' l -F Existing Zoning
Parcel Owner: OYyi C V l Qld7li`y�'ls �C OIIOR Llu�4;told_trall
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Parcel Address: 3 30 C 6reoto nT �LG� if City C,fQ Z4f,* State Y � Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? -- GlitJrZ1 (_ t p_.bUIQM
Address : so `l A �4>n h OVN,4a_ t� RJ . City _ A _�6 State VA Zip a%'90-0
Office Phone: (:9(0 qS-(p —a (01% Cell #43g40-90'? Fax # S'0 4S� -q61 7E -mail 10,yrR&A,51 y5� - CA-MA
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name/Type: U ; LL C ,c
Previous Business on this site U U 5 01
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional infortgation that you can provide: v ,
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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 Zonihg
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 4ave read the conditions of approval, and I understand them, and thatt I will abide by them.
Signature �V Co L°-woi^
Printed rzi. f • `
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Back low 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 K. Date
Zoning Official Date i�Z�Z j'3
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 /ICI
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/ I)
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 ublic water?
If private well, provide Healt 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 o ublic sewer?
Y /KD
Wil you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y / nN
Will -Mere ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zonin , to complete the followine:
Reviewer to complete the following:
g
Square footage of Use: !d-
6/ N
Permitted as: /� G�� _(�4�, 7 o X11 e✓ �ckt ei
Under Section: 2674,
Supplementary regulations section:
Parking formula: /
�4'0
Required spaces
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/A
If so-, List:
Proffers:
6/N
If so, List:
Va ' ce:
Y/C
If so, List:
SP's:
-0 /N
If so, List:
Clearances:
SDP's
2 yr� .9
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, 26✓! i L,5 ( eA4w tx- eL
[ unty application name and number]
was provided to -Ty 4l F 0 we-9, Ck e ay ve- p,)rec p c the owner of record of Tax Map
[name(s) of the record owners of the parcel] Lei �e p� V r t'% YLt 6rtiSl�r L' V'�
and Parcel Number 330 C (a re, Lt4941444 (,0? t
by
delivering a copy of tfifie application in the
manner identified below:
Hand delivering a copy of the application to TVO�'�j (�jO�t/q, C-Ket
[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 7 AR-
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:
[address; 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].
Signature of Applicant
loxvra. F. CO /e,14,�
Print Applicant Name
Date
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