HomeMy WebLinkAboutCLE201300238 Legacy Document 2013-10-04Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # 016 Staff:�
PARCEL INFORMATIO
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Tax Map and Parcel: ' Existing Zoning
Parcel Owner: b �11- N'l D 1-� I (
j5,3lp 0 d J-�' ( C` II City Ch' \nl k-) State Y Zip
Parcel Address:
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? j 6, Y�
8.1 �(`'6 Pf City 1 State V Zip x'31
Address: I /41 �.
/
Office Phone: (_� Cell # F ax # E -mail
APPLICANT INFORM4,T ION
Check any that apply: Change of ownership Change of usee Change of name New business
Business Name /Type: b,#R L &2
Previous Business on this site
Describe the proposed business including use, number of employees, number f shifts, available pa kin s aces, number of
vehicles, and any additional information that you can rovide: &. " o e — ��
a t✓ c°e n cx
*This Clearance will only be valid on the parcel for which it is approved. If y6u change, intensify or move the use tda 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 accuratg-to -th • st of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature s —� Printed
APPROVAL INFORMA N
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
Zoning Official Date /,.1 14 Zz 4E
Other Official Date
County oI AiDemarle 1JUPH, wucuL vi wu XIUIL. j — = Y - - -� --
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:
Is/
Is us n LI, HI orPDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y Nj
Wil 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 public water?
If private well, provide Hea i epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic qr public sewe .
Y /
Wil u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Wil re be any new construction or renovations?
If obtai
Permit #
Reviewer to complete the following:
Square footage of User ` i S Z/ /
A/ N
ermitted as: Y4" ))
Under Section: ?�L • 1
Supplementary regulations section:
Parking formula: L )
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
LWIL11r, LV LV111 MLLi Lll t. aVaav r�aaa
Violations:
/N
If so, List:
Proffers:
N
If so, List:
6 y�zj
6.9 �S
ariance:
N
If so, List:
SP's:
(/N
If so, List:
�3 -y
Clearances:
SDP's
3n
Z'
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
[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 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].
X
Signature AApaWcant
Print Applicant Name
Date