HomeMy WebLinkAboutCLE201300169 Legacy Document 2013-08-05Application for Zoning
Clearance
CLE # 200 ' l
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE.0 Y
Check # l I Date:
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: ` -51 - i Existing Zoning
Parcel Owner: - -Z1 SS PRo ft_e- -n —
Parcel Address: Zei2,� ,00'zt132oo,�— 1.n City tA_yycz�,c -,"iTEAVjt _State Zip Z2clU1
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address: 002 jt:4 City W-fiv -vu v1u£.. State ( Zip 2.21oJ
OfficePhone:(y3y� Z�� ���r1� Cell #toy i�1 X83 Fax #43`i X26 -i117E -mail ►- \t�C��U�N6 ►'}aL,C_ �1,
i ( t-LG YaUW CAG L. Ctpq
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: ° \i_LX ANN. & 1 oy G-0—
Previous Business on this site
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: 'CQ L ^I >✓ �vt > > f ,�h f A ,�
L
*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 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 have read the conditions of approval, and I understand them, and that I will abide by them.
Signature `` Gv n Printed U h l i" C '12006
ly
AP7ROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] $ackflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ 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
Zoning Official Date d -1
Other Official Date
County 01 Alnemarle LeparLmenL of L.uuuuunuy Lcrcw�uic ■a�
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: Reviewer to complete the following:
Y/ N Square footage of Use: I r y 7'
Is use ' LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. V N
mitted as:
Y /NO on
Will there be food preparation? Under Section:
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o public water?
If private well, provide Hea ment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that appy'
Is parcel on septic or ublic sewer?
Y
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
W� d, re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nn;"n +r% -nmrAPI-P the fnllnwina_
Parking formula:
Required spaces:
Y N
Violations:
YIN
If so, List:
Proffers:
YIN
'If so, List:
Variance:
YIN
If so, List:
SP's:
YIN
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 the
owner.
I certify that notice of the application,
[County application name and number]
was provided to
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
,X 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
[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].
A; �� �10o,A A
Signature of Appl ant
Print Applicant Name
O
Date
a
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