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HomeMy WebLinkAboutCLE201300057 Legacy Document 2013-10-17Application for Zonin�Clearance CLE OFFICE USE ONLY :? Z-) .4 2 Date: O ' 0,--7 PLEASE REVIEW ALL 3 SHEETS Check # Receipt # ] Staff: PARCEL INFORMATION y� ff -U � Q6 ` � " Tax Map and Parcel: f(9 l 66 1 Existing Zoning Parcel Owner: l✓ DENS Parcel Address: 2�C> ZC>Lvb 7L • "I0 City t.RAR_1.OTTF-SV 1U5tate VA- Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? C nn Address : ✓��_�,lt'i L G b4-hVl t4 �R.City SaOTE -1 Rlt�) [N� State /`I' Zip -Y Office Phone: CW3) 3 Z74-16? -KCell # 14 /1- 6g7OFax # E -mail G • APPLICANT INFORMATION Check any that apply: Change of ownership LZChangeofuse Change of name New business Business Name /Type: 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: N 0 l i _Nk 4' &M 7- r-H If) ?"1 r\,Ar- �-S' *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 accur _tb the est of my owl ge. I have read the conditions of approval, and I understand them, and that I will abide by them. �QF Printed P C W FV A V" Signature APPROVAL INFORMATION []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 `i ( Z `(�/ 5'lf �b l /f3f2 �� Zoning Official Date �,,� � —z— Other Official Date County of Albemarle Department of Community lieveiopmenr 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax:-(434) 972 -4126 Revised 7/1/2011 Page 2 of 3 tt•C&m ,I Intake to complete the following: Reviewer to complete the following: Y 1(N ta Square footage of Use: Is us LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ( / N r Permitted as: Y/ Will ure be food preparation? Under Section: ;P/,, C' o. )t 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 SP's: Y/6 If so, List: Circle the one that applies Is parcel on private well or p blic wa�o Parking formula: Z1,S Required spaces: S If private well, provide Health a ment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Y/ Circle the one that applie Items to be verified in the field: Is parcel on septic or ol6blic sewer SDP's N ll you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: N Notes: ill there be any new construction or renovations? If so, obtain the roper Pen Permit# 7.nninR to emmnlPtP the fnllnwinu-- Viol �t ons: Y if (iQ) If so,ii``st: P} offers: N If so, List: 2� Varia e: If so, SP's: Y/6 If so, List: Clearances: SDP's O —Sn 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, T5 ZD « ` d©60 [County application name and number] was provided to E�/> )�- 5 • 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] M Date eMailing n to 2 cony �f the application [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 �j /2"/2O �� to the following address: Dat , -(ro w 1 S GaWS ! 1ti1 �U� bo rE�7-tf M b [address; written notice mailed to the owner at the last known address of the owner as shown on ?Ag l the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Print Applicant Name 31,2 7-- Date