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Home My WebLink AboutCLE201300185 Legacy Document 2013-08-19Application f ®r Zoning Clearance ��F,,,,�� 6 OFFICE U O LYVa PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORM O /1 Existing Zoning CIA Tax Map and Parcel: VOM�AAULI Parcel Owner: / City 1� (/ State v TL�p�! Parcel Address: (include suite or floor) PRIMARY CONTACT Who should we�cfal�l /write concern' g this project? r �( Address :_ r V , V $c-- City CC�G\ _ State 7`rt Zip- el Office Phone: G r l -` Fax _ APPLICANT INFORMATION Check any that apply: Change of ownership Change of u7se' Chhannge of name New business CvIUL_�D Business Name /Type: _c ( 4r;,,� Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, nu ber of - vehicles, and any addition 1 informati n that yoij can.Dr vi e: /Vll_ -r • -c J -� S tC �S *This Clearance will only be valid on the parcel for which it is a proved. If yo change, intensify or m1ve the Ise 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 accu�ra�tep to�l�e bbjestlof my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signatur li(.4�` >`wV Printed APPROVAL INFORMATION [VApproved as proposed [ ] Approved with conditions [ ] Denied [ ] ackflow 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 t �L t3 Zoning Official 1. VIA Date f Other Official Date County of Albemarle Department of t.ommumiy MevelUPIRCUL 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 X01, Is HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y / Will Ore 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 p blic wat If private well, provide Health ment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applie Is parcel on septic or p Ssew 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 # 17--.-- +n nmm"la +a +ha fnllnwina- Reviewer to complete the following: Square footage of Use: Permitted as: Under Section: cw , b • Supplementary regulations section: Parking formula: 6F�U `/M l t f— &V 6A 67 Required spaces: uv as aaa Violations: Y/N If so, List: Proff Y/ • Ifs , ist: Variance: Y / N If so, List: SP's} Y / If so, ist: 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 ' La 2 the owner of record of Tax Map [name(s) of the record owners of to parcel] and Parcel Number L45 - O S 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 [Name of the record owner if the I c rd owner is a p rsor if the owner of record is an entity, identify the recipient of the record an e recipient's title or office for that n``tity on IVY 3 to the following address: Date the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. C�Qltc�✓�t X21 huk fttnlh1tlt i�wS �fm --, *, Signature of Applicant Print Applicant Name Date a on, gt) I �n =� �-� �s ,� .� �� v� �� .� 0 �: