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Home My WebLink AboutCLE201300161 Legacy Document 2013-08-08310 IV, I Wit Application %r Zoning learance pp CLE # 2b I() - I b I g �r; •' � PLEASE REVIEW ALL 3 SHEETS OFFICE USE ryONLY Check # " I 95 Date: J Receipt # Staff: MKO PARCEL INFORMA n _ 4- Tax Map and Parcel: Existing Zoning jj,,��,,,, �/� c� Parcel Owner: P�,�i,�� ;} 2 OW1 � C�a Parcel Address: / rlq,, 7 Mpr � city C 4401' 0AL, t(k State Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? 1 S 'bc,.�y- --, q j ( Address :PD D go D City 60-tWt I le— State Zip Office Phone: Cell # Fax E -mail J& ac_ . APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business [ Business Name /Type: (�JePrevious Business on this site AA 4 '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: *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 a urate the best of knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signatu Printed/, APPROVAL INFORMATION t;,4Approved 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. Notes: Building Official Date �_ 6 fit Zoning Official 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 r A e + Application /fo�/r" Z%�oni^n Clearance CLE iT !/ate (J w UJ Rk 7l e e < ,fin PLEASE REVIEW ALL 3 SHEETS PARCEL INFORMATJ f Tax Map and Parcel; �jj Parcel Owner: Gj Parcel Address: /! A 1Lt ri� ?ltr� QA1 Existing Zoning C"1(U{/j (2)M MOOS citydar�p-f 4,oA LkIle- State- ( Zip (include suite or floor) PRIMARY CONTACT JJ Who should we call/write concerning this project? Address :PD 90g. t H AD City t l le- State Zip Once Phone (y Cel #i%(,� IINI Wax #� -yoo- I(�E mail it &&-, b na-� f-"' le, APPLICANT INFORMATION Check anv that annly: (hanoaa of nwnarchin / Chdr,en nftiten rl,e— .,r., ..., t. Business Name/Typec'y:�kr 6— 1 Ma-4' P,S I QtA' TQ— �'G ls�f Previous Business on this site we 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: `This Clearance will only be valid on the parcel for which it is approved. If you change, intensity or move the use to anew 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 "ue a urate the best of knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signa Printed- -} ("(a APPROVAL INFORMATION [ J Approved as proposed [ ] Approved with conditions [ ] Denied j ] Backfiow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x1 17. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a detennina6on of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date Zoning Official bate Other Official Date 1- �.Vuuty oa niunriGNUyurtmear . vl %,ummunrry.vevetopment 401 McIntire Road Chat ottesville, VA 22902 Voice: (434) 296.5832 Fax: (434) 972 -4126 Revised 7/I/2011 Page 2 of 3 Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. /N ill 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 lie ter? If private well, provide Hea 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 o pill is se 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 Permitted as: � nc% e *,A Under Section: Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y/"fi If so" fist: P offers: /N f so, List: Variance: (� /N91s: 6,)/ If so, List: { n/ P's: If so, List: p 7 �r19� 5S'c7 ?Sl� 2S 9 0— 31f Clearances: SDP's �9Wiy, 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, was provided to [County application name and number] [name(s) of the record owners of the parcel] and Parcel Number manner identified below: Hand delivering a copy of the application to the owner of record of Tax Map by delivering a copy of the application in the [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]. Signature of Ap licant Print Applicant Name 9% Q// 3 Date