The URL can be used to link to this page

Home My WebLink AboutCLE201300164 Legacy Document 2013-09-03Application for Zoning Clearance . 1 1177(.71�' OFFICE US O PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff. PARCEL INFORMATION - - - - -- - Tax Map and Parcel: Existing Zoning �C--- Parcel Owner: ��h`! C'� Parcel Address: -a' ity _CJ--rA4ecdYtate Zip (include suite or floor)5� PRIMARY CONTACT Who should we call /write concerning this project? Address: ��I�T d! , h(X City C. (ol/ C071 A/ `, ,/State VHb I Nl /) Zip 3 r; �y�33C 7 i Office Phone: ell # Fax # E- mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: _ � (`T �� S p-e !� t-,16H 00 A i 11 A-( � jG / S Cldl-tL Previous Business on this site NE NF J/ (1"� Describe the proposed business including use, number of employees, number of shifts, available arking spaces, number of C vehicles, and any additional information that you can provide: iV1 ��'f =fie A L2' SCI 'Ln cam/ e'I I t L e w (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. 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 II understand them, and that I will abide by them. Printed ` 1 F—/,/ 2� Signature f — APPROVAL INFORMATIO ['>TApproved 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( Zoning Official Date %1Z ) &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/l/2011 Page 2 of 3 In P to complete the following: Reviewer to complete the following: Y / N Is us n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / - Will-ere be food preparation? Square footage of Use: l II ✓ , 6 / N ^' pbb-1 -C�� Permitted as: i N H � Under Section: 2 >A • 2 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 wiie:Rtform. Parking formula: 'A`/Y4 �i'��D�° If private well, provide Health epa Zoning review can not begin until we receive approval from Health Dept. FAX DATE Required spaces: Y/ Circle the one that applies Is parcel on septic or ub is sewer? Items to be verified in the field: SP's: /N If so, List: N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. °r A //Av S G r' Permit # Inspector : Date: Y / N Will there be any new construction or renovations? Notes: If so, obt Permit # ' 7.nninrs fn emmnlPtP the fnllnwin¢_ Violations: / N If so, List: Proffers: L/ N If so, List: ly ariance: l/N If so, List: bi SP's: /N 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. that notice of the a 1 certify application, [County application name and number] was provided to o�� Q .2 Q 4. the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number C) _2X� Z566 t� LIEU by delivering a copy of the application in the manner identified below: Hand delivering a copy of the application to Q [Name of the record owner if the recor 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 7 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 )t to the following address: Date [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]. Lc �Sig ature of Applicant Print Applicant Name ADate m , 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, ? / / (�G /�S F�G��'� —b' -0 QQ [County application name and number] was provided to hew �� -� -� the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 63' � by delivering a copy of the application in the manner identified below: / I/ Hand delivering a copy of the application to��L'� [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 Lac,— �1 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]. Print Applicant Name �? 91 �o Date , r m< :(D 0 'l- 0 - 25' -0" T-6" „ 6'-0" m X 4 m O� O c E -- - -- - -4 - - -- - -- - m N `l 0 0 w V N 1 Q � C � C