HomeMy WebLinkAboutCLE201300186 Legacy Document 2013-08-22Application for Zo ing Clearance
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OFFICE NLY
MS _S- 13
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # `° Staff:
PARCEL INFORMATION q .ray /j'
Existing Zoning
Tax Map and Parcel:
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Parcel Owner: AL-0 / &A' r"k - _
-
Parcel Address: �c�� �ID/J1CcS%� City (/��lr /Gti ►�o /IP State (%h Zip'
(include suite or floor)
PRIMARY CONTACT
Who should we call /writec'oncerning this project? i //G/1�%/�
Address: ,� � .T�41 (')S-4 /✓ f- City State Zip
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Office Phone: Cell # ftI;4 Fax # E -mail
APPLICANT INFORMAT
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 64wa,k e
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking s aces, number of
vehicles, and an additional information that you can provide:
zao
*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 a best of knowledge. i have read the conditions of approval and i understand them, and that 1 wi 11 abide by them.
Signature Printed
APPROVAL INFORMATION
[/Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 17.
[ ] 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 / l
Zoning Official W(V Date
'G4 Other Official ��,, �� �7t �(�l t1�� Date �3
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126
/tt Co rX. - - -- - --
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Intake to complete the following:
413
Reviewer to complete the following:
Y / Square footage of Use: J
Is usE)LI, HI or PDIP zoning'? If so, give applicant a Certified
)Y1gll ineer's Report (CER) packet. YO/ N Permitted as:
N 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 applie
Is parcel on rivate well public water?
If private 4 - e Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the o that ap lies
Is parcel septic o ublic sewer'?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/ N d 11�iJ1 J Y l
Will there be any new construction or rvations?
If so, obtain the proper Permit.
Permit #
i/bY--,r
Zonine to complete the followine:
Parking formula: 15, ° v b �S• a— 3
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Required spaces:
i M / N J ►
s to be verified in the field:
Inspector: Date:
Notes:
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Clearances:
SDP's
Revised 7/1/2011 Page 3 of
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Ready to Eat and
r Custom -made Breakfast & Lunch
r Fresh in -store Baked Goods
r Sides & Desserts
Daily Specials
ABC -off Beer & Wine
� Cigarettes &Tobacco Products e r Basic Grocery Supplies
Proprietors: Michael Eurell and Mackenzie Eurell
ne2shoprtHftmail.net 0 www.me2shop.net 6, 434-297 -2201
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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,
JJ [County!/ application name and number]
was provided to / e A Pr f? �Y e7 �1 ra4&led- the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
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].
Sfgnatfire of Applicant
I", a/
Prfit App 'cant Name
.Y/e / °�
Date
d! V r, V'bR�S
r
ro v
Application for Z to ing Clearance
CLr" w i
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OFFICE NI,Y
PLEASE REVIEW ALI, 3 SI C+ ETS
Check # Date:
Receipt## " Staff;
PARCEL INFORMATXON
Tax Map and Parcel: Existing Zoning��
Parcel Owner: lC,z ,c
Parcel Address: �D/1�C SH 9 �iCity r b laf % State GBH Zip
(include suite or floor)
PRIMARY CONTACT
�^, J
Who should we callAyrite concerning this project? 7 & � 1�L`ioe
Address: S�"t� "C�� -i�) %% r- City State Zip 4
APPLICANT INFO T
Check any that apply: Change of ownership Change of use Change of name _LNew business
Business Namell`ype:�,r
Previous Business on this site
Describe the proposed business Including use, number of employees, number of shifts, available parking paces, number of
vehicles, and any additional information that you can provide: 2 !N 'ls i
� r
"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. 1 also ceclify that the information provided
is true and accurate to a best of my-knowledge. l have read the conditions of approval, and T understand them, and that Twill abide by them.
Signature Printed A,�
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backi'low prevention device and/or current test data needed for dtis 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 i l qi 3
Zoning Official Date
Other Official C Vii^ ,P Date___r /% �!
County of Albemarle Department of ConrmunityDevelopment
401 A•feintire Road Charlottesville, VA 22902 'Voice: (434) 296 -5832 Fax: (434) 972 -4126
Ine,