HomeMy WebLinkAboutCLE201300220 Legacy Document 2013-10-11Application f ®r Zoning Clearance
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OFFICE, USE ONLY 4 �, fp t-
PLEASE REVIEW ALL 3 SHEETS
Cheelc# Date: �`
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: 1; xis g Zoning
Parcel Owner: rOsS C60%
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® City' State 6�- Zip2�
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Parcel Address: •
(include suite or floor)
PRIMARY CONTACT \ �S�o �.
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Who should /write this project?
dw,,e11call concerning
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`i 1 D o l tooL- - City � - 1 k1*- State Vim-- Zip 0790
Address : 1
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Office Phone: Cell # 71 •3Z1 1 • 5 Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Chan a of name New business
Business Name /Type: 55
t 1
Previous Business on this site—AA tJL
Describe the proposed business including use, number of employees umber shifts, available parking spaces, number of
Nb
vehi les, d any additional information that you can provide: W yc.� —wiz
*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 o r have the owner's permission to use the space indicated on this application. I also certify that the information provided
kno ledge. I have the conditions of approval, and I understa d the ,and that I will abide by them.
is true and accurate e st of my read
Signature Printed d 3
31�
APPROVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ j Denied
[ ] Daflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[i,,fNo 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 d Date t 13.
Other Official Date
County oTAtoemarie mepartmentoi %- utn,[euuuy Lcyn,Opim —Aa
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -41Z6
Revised 7/1/2011 Page 2 of
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP Zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
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 or public 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 public sewer?
Reviewer to complete the following:
Square footage of Use:
/ (04W I-
N ' �W PjC.F°
•miffed as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: °I
Nse Ite verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit. Inspector
Permit #
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
n
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LUI11it W L;U111jJ1VLV Li101V11VT7111 .
Viot ns
Y �
If s ist:
Pro es
Y/N
If s ( st:
riance:
Y/N
so, List:
SP's:
�/N
f so, List:
6q
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDODVNER.
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
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
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 Iast 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].
Signature of Applicant
Print Applicant Name
Date