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Home My WebLink AboutCLE201300269 Legacy Document 2013-12-03Application for Zoning Clearance CLE # — �- PLEASE REVIEW ALL 3 SHEETS OFFICE U Y Check # Date: Receipt # Staff- PARCEL INFORMATry N / Tax Map and Parcel: ,�� -l� Existing Zoning 1 PD C� Parcel Owner: ALATr Red?F•RT /E- S , L 4 C Parcel Address: /SY Aky sEN go, Stun 261-A City rmARLIA>r yit cC State VA Zip 22411 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? DAl_ti SHooP 6,M. U4LL8r SoUT1lER,� TJTLE Address: 19 $RIAR iCNOL,. GT 9tl! -,t. z City State X4 Zip 22939 Irs7 /rGE.ao�y Office Phone: (1 -yo) 213 -a4,ll 9 Cell #5W. 27!• /yGS Fax #,S'yo• y87309/ E -mail _p/•1 LG. J'Hao /C (�p� =... APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name ✓ New business Business Name /Type: 1/S7*/rLE _/ 7'1rLE 1,VdW1At&S A' R6.41 ES7A74: SE7/•6air,6*'T5 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: 1 RCS pG S SIa„ At- oAOME A 16MPAVV&.V . ?A?KIN6 SPACE , I I/BH/GL.G *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 understand them, and that I will abide by them. Signature Printed 7AL1: SNOOP APPROVAL INFORMATION >J, Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xl 17. [ ] 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 ( � Zoning Official Date oz/-76/2 Other Official Date 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 Intake to complete the following: YIN Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. YIN 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 !p Is parcel on private well pd ublie w er? If private well, provide Healt epartment form. Zoning review can not begin until we receive approval from Health Dept. _ FAX DATE Circle the one that-apC;licr? Is parcel on septic or YIN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YIN Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: / V o 3O/ N ,,n (�� Permitted as: �'�C -1-1 GL, Under Section: Supplementary regulations section: Parking formula: l/ Required spaces: Y/ Items to be verified in the field: Inspector: Date: Notes: Violations: Y/ If so, ist: roffers: 9/N If so, List: �l�vi� ZN2~ Variance: Y/ If so, List: SP's: Y/ If so, ist: Clearances: SDP's 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, Zo1V/N6 c ,4MIV46" [County application name and number] was provided to IOZ/a7T yRopy, rj&j . 6Gc- the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number manner identified below: 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 ✓ 6-Mailing a copy of the application to acs Vc�rr ,¢ova ICX !.� e [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 m • ZS• 2a/3 to the following address: Date SA1 to &- PLATMIXIANGIAG. cam [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]. Signature of Applicant Print Applicant Name /o- 2s"- 2.0S Date �y I� Suite 202 -B Suite 202 -B Suite 202 -B Suite 202 -F Suite 202 -E Suite 202 -D \I Closet Closet Foyer Suite 202 -B Elevator Kitchen Suite 202 -F Waiting Area 11 ' Suite 202 -F Conference ILI Suite 202 -C Room Closet '� Suite 202 -A Reception Back Entrance hone /oat Platt Financial Closet