HomeMy WebLinkAboutCLE201300224 Legacy Document 2013-10-01Application for ZoninLg Clearance
CLE # G
0
PLEASE REVIEW ALL 3 SHEETS
OFFICE USr(� '- .� ✓'2)
Check # �jj-- Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 5 D2 _ 1 `° ! D Existin g Zoning �`I Ow
Parcel Owner: ✓�-�-
Parcel Address: 4e-�d P[.,cL, Sx.'L 1bij City G 't ti State Zip 22` Z
(include suite or floor)
PRIMARY CONTACT qQ
Who should we call /write concerning this project? U ��✓`
Address : Dai "J CityC� � SVI �^� _ State Vj, Zip
Office Phone: i( $4) 2U2 —b5-q 1 Cell # (Lt311, `iS�i�- �9bZFax #t yp� ��1Q, M,. E -mail 4 ;P,' e�• eo �-.
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Co",SLJ
Previous Business on this site
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: %A&A -c
2 � -,-e s -� M -F P�,�k.�, 1a -e4� r les
*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 I understand them, and that I will abide by them.
Signature �� Printed CJA ` tO�-
AP OVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] flow 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( Ff
l�o
Zoning Official /Z, �' Date �l
Other Official Date
County of Albemarle Vepartment of t;ommun ty 1JeverupnienL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
U � '
U
Intake to complete the following:
Y/0
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will ere 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 ublic water
If private well, provide 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 septic or ublic sewer? �
Y 16)
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /&i
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: W
Q m tted as: a `
Under Section:
Supplementary regulations section:
Parking formula: t
Required spaces:
Y/
uvaaaaa
Viol ' ns:
YINN
If sOMS't:
Prof r :
Y/�
If so, ist:
Vari ce:
Y/N
If sost:
SP's,
Y/
If so, ist:
Clearances:
1
All !j
0 �(a1'I�
SDP's r ��
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PIT
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 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 ckX& 10, IF : qA
[Name of the record ner 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 to the following address:
Date
V
q Gay(; . Gam,• I �ksv� 1-c Or 22`w -1
[address; written notice mailed to the owner at & last known address o`P the owner as shown orf
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of Applicant
� Print Appl cant Name
��r7�2ot�
Date e
i I
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