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Home My WebLink AboutCLE201300248 Legacy Document 2013-11-260 roo cN-a-,nvo6h./ Application for Zoni• n Clearance fizti. CLE b48 PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY -, Check# bate: # Staff: rfW- Receipt PARCEL INFORMAT ON .�%�a Tax Map and Parcel: l ' Existing Zoning Parcel Owner: , b )4W L/ A J, aI City l/� I, k State V Zip4q_)1 Parcel Address: i (include suite or floor) PRIMARY CONTACT _ �� U��-�� suy Who should we call /write concerning this project? C� Address: 01C Nb it'll W 10 Pp/O• City �,{'�zr�ai"t�SVI�� State V Zipz l ()Z Office Phone: (M) 17-7 ell #9,S4 -efg-f 54ax # E -mail �rC✓�da SreS� cr c ��c� �+ (� ilm� r a APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name N`e w� business I I Business Name /Type: qne)s Previous Business on this site n e LIS ( )U 22�� Describe the proposed business including use, number of employees, number of shifts, av 'fable parkin space , number of information that can ew 3 to vehicles, and any additional you provide: ^ 2.r *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 them, and that I will abide by them. understand Printed" 8r nl Ya iU,,,, raj k, Signature y APP VAL 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 0 / :4 � Zoning Official J9 Date ' 6 h(013 labOther Official 1 Date ��_ - ,v County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3, ao 0V cab Application for Zonin Clearance CLE # off US 40 Y Date: PLEASE REVIEW ALL 3 SHEETS Check # Receipt # Staff; r PARCEL INFORMATYO�N � N H Tax NIap anti parcel: Existing Zoning Y i`((, Arvid Parcel Owner; "�/tb "J�, po �� City vwc State Zip Parcel Address:!t.rta?b �� __ (include suite or floor) PRIMARY CONTACTU��{ -Scrr� �2t'11�z Who should we call /write concerning this project? 1-7jC) Phi City State ZIpZ276Z Address; ;41'00 -& Offiee. Phone: (,13)) -7 `i /sell #43 - —81W- f�4axfF )J- nrail�Ydnd�Sres�actrc„t i-(�'{ APPLICANT INFORMATION Cheelc any that apply: Change of ownership Ciinnge of use Change of name New business BusinessName/Type: Previous Business on this site car e L iS t , u :kw Describe the proposed business Including use, number of employees, mtm er of shifts, av lable p ricin space , number of 01 (ine 3 i'PVt` vehicles, and any additional hiformation that you can provide: r S, *This Clearance wilt only be valid on the parcel for which it is approved, If you change, intensify or move the use to a new location, anew 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 tile best of my wrowledge. •I have read the conditions of approovval,l,' and I understand them, and that I will abide by them, Signature ��(1'� -� Printed PJiI�� i' ?2�1 tit APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention ice and /or current test data needed for this site, Conkack CSA, 977 -4511, x117. [ } No physical site Insp t n ba d t t le ice Therefor It is a t doterinination of cowl lance with the existing site plan, [ ] This sitecoinplies sit pia a ft te, Notes: Building Official Date Zoning Official Date Other Official `Z i �f S Data //AQ n /..- IiVUII{.•j' V1 tMuii"'a. av Yvli,.a us...... vs .. ............ ...J -. - - -a - - - 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax; (434) 972 -4126 Revised 7/1/2011 Page 2 of 3,- ,VGA mq �2 � 1. Coat,,, q4n ) Intake to complete the following: F IN Y /N Is us LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. V1 N Will there be food preparation? If so, give applicant a Health Department form. Zoning review can not be in unt 1 we receive approval from Health Dept. FAX DATE Circle the one that es Is parcel on• rivate we , or public water? If private we 1, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the�R&Ibat applies Is parcel on septi or public sewer? --,\ � Y/N ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. n I Permit # n, ICJ O�� Y (/-N--) (V1161 b 1. A t re be any new construction or rvat If so, obtain the proper Permit. pA Permit # Vnnina M ommnh -h- The. fnllnwin¢/ Reviewer to complete the following: Square footage of Use: I ermitted as: Under Section: l V Supplementary regulations section: f q-6 Parking formula: Required spaces: (l� Y N) ItenVto be verified in the field: / Inspector Date: MAN Vio a )n,: Y N If s ist.. Pro ers YIN If s , ist: Vaq cc: Y ifs , N ist: SPp Y Ifs Clearanc s: �d r l SDP's j s W t Mfg- rfN)V*h 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 [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 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]. nature of Applicant x' Print Applicant Name �( zz ,X 3 ' \Date II ----- - - ---