HomeMy WebLinkAboutCLE201300251 Legacy Document 2013-11-07Applicati ®n f ®r Zoning Clearance
pp �ll.11f.
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CLE # 20 3 �5
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # (2 22 Date: i o -24- - 0
Receipt # Staff: '-
PARCEL INFORMATION JEW
Tax Map and Parcel: 051,A - (`�1-C7�— uG�.)�l Existing Zoning[ ClY1YY1i�lc iCbi 'rFi,� �l. v�
CC11
Parcel Owner: JI��1I�,L.�G£3�h�1tC
Parcel Address: J ►1 j (GVr`e Y Si`ru ,� City State VA zip
(include suite or floor)
PRIMARY CONTACT
ctin P-
Who should we call /write concerning this project?
q
��` ���Q �a'l� �1�. City (- 1GWj() HeM t&ate V, Zip
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Address : i� -
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Office Phone: q J' �- 5 (o Cell #q! - q t._ ,588 ax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name ew business
Business Name /Type: A f We y
t
Previous Business on this site�t�VTIS(l�G►�SG'SVl t���'1TT�C����1- , ► 6mS
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: 2:4-61/ i -'W e& pf(-, orvl
U� evr► e 5 s on ,- ew rcc e
*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 m knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed MUal
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 (D ��E- �(
Zoning Official Date Al 2c>I
Other Official Date
County 01 A1Demarle LeparCmen u1 L.u[ttluuiu Ly LVyC VFXIIa A&
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:
Y /
Is usQiLI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y N
Wil e 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 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 applie
Is parcel on septic o public sewer?
(Y)/ N
tll you be putting up a new sign of any kind? If so, obtain proper
Sign permi
Permit #
Y
Wi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7 ,,, :,,.. 4- ...,rnr,1 +a +h,- fnllnwina-
Reviewer to complete the following:
Square footage of Use: %b
0/ N /� /
Permitted as: �{-_ nv;1t- -rte-
Under Section: 2.0 -P. I-
Supplementary regulations section:
Parking formula:
Ja c�
Required spaces:
Y I
Items to be verified in the field:
Inspector:
Notes:
Date:
IJVlllll VV l.V 111 1V 1V .
Violations:
YIN
If so, List:
Proffers:
Y/
If so,-List:
Variance:
If so-,List:
SP's;•�l
Y / jo
If so, List:
Clearances:
SDP'
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 Ahn aem io �VIGiGDl�})r► JG� �C the owner of record of Tax Map
[name(s) of the re ord owners of the parcel]
and Parcel Number QS 6A A ( - U 1-00- -6000 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]
ut
Date
Mailing a copy of the application to /� m Sian IL'�t� x Wl�rn �� �n t�� �
[Name of the recordlowner if the record owner is a pe on;
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 10 -2 - +Q� to the following address:
Date
[address; written notice mailed tot e 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].
Signature pplicant
e j-i C y Ke-.I
Print Ap cant Name
Date