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HomeMy WebLinkAboutCLE201300206 Legacy Document 2013-09-10Application for Zonin Lor Clearance'ff'' ' CLE # DIDIZ2—JOC PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # 116 q(; Date: 9'(� 'l Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: 0 (p l QQ - Q 0 - (-)0 - i aS Q Existing Zonin Parcel owner: 0 i'Y�1 �-7` t-1-C © loatl-e5yl d2, _ ��� J 1i (� �>zo- Parcel Address: 1=] l Q S'P�rnl/)0 lt' -tax 1 l�JK- 9City (D'1011(- 10-V+e it 116State (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? n Address: 3a (�Ql -q- -6`(' yo Qlad city Riwwe2y 1 l0 State kA Zip i. Office Phone: 69�6) it 14?t;-713 -89OFax# 3 %- 02-4 -mail ! + C.��(p �i 11t7Aw 61' �T•co APPLICANT INFORMATION Check any that apply: Change of ownership. Change of use Change of name ✓New business Business Name(Type:F�[ aL Udf its Luc- tbL4A'4 - r'flmnrn.Lge-A- r pIc Previous Business on this site C ko' i' 1 O*S1! 1,11 U S) c 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: Ill Si�cc��rI 1� Mond cr<at, s:adan,- D.r\jL \time&. 1 An � ►n + SO4 a eU Y +S aon *This Clearance will only be valid on the parcel fo hich it is apprc ed. If you change, intensify or move the use t6la new location, a new Zoning Clearance will be required. 1 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 th.A best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature U'l Printed APPROVAL INFORMAT40N Approved 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 c2 l -t [ca 3 _ v Zoning Official ,r. 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/l/2011 Page 2 of 3 :Intake to complete the following: Y / Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet Y/6 Will 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 o ' ulfljf orate . If private well, provide Heth..Depar-tnfent form. Zoning review can not begin until we receive approval from Health Dept FAX DATE Circle the one that applies Is parcel on septic orubiic sewe . Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / 6) 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: I & OD Y) / N � Permitted as: Under Section: 2 y " Z . Supplementary regulations section: Parking foxmula:��I l' (At c, Required spaces: Y/N Item o be verified in the field: Inspector • Date: Notes: Violations: �Y /N so, List: Pro s: Y/ Ifs ist: Variance: Y/0 If so, List: SP's: Y/C If so, ist: Clearances: SDP's Revised 7/112011 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must accompany zoning applications (Horne Occupation, Zoning Qearance, Zoning AdministratorDeterminatfons 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 1.7 (D Cpl i fj Ip T i . 1-1 the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 0jo 11)) _ a36C) 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 17 10 S2rv�;Y�o le -T`✓ aL l , Ll,C Date 610 C.BRG - Chca,r'iotfesvi (�2� 1� Mailing a copy of the application to o W neA— + J--,A 10 r 1 wd S i �2 {` [Name of the record owner if the record owner is a per': n; 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 fe Jn 1'7 to the following address: Date [address; written notice mailed to the owner at the last known address otthe owner as shown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. PP Signature of A licant Print ApplicAnt Name fir- j ���.__�_ -�__� I _ ��,_� � - -ft, �7if I + I F