HomeMy WebLinkAboutCLE201300289 Legacy Document 2013-12-09�u 1011
Application for Zoning Clearance
CLE # I re,,( -i
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O
Check # Date: 2 - -
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: �2 Existing Zoning
Parcel Owner: 1` o'e
Parcel Address: SW City C� W #'�U1�� State `, /V7 Zip
(include suite or floor)
PRIMARY CONTACT
Mn ' ' 'C'� Z
Who should we call/write concerning this project? 0L t� /
Address: ) jt — &Vile '0(_% City(1)4CkkCT yAa State Zip
Office Phone: `( gq) ^ dN) Cell # Fax #2111 E -mail 57e,ivr6 (,Q W 1 f_, � A& t AA
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Chang1e of name
y /N�ew_pbus�inesss
Business Name /Type: Pl e &1,U l LJ 46;,,)� �� L�4� -G L l-P r JI yis b6"ti_ rfl Jar"- )
nn nn..
Previous Business on this site � �r�1y`¢ro�`" ��tfi+ � �, i ��,D�_4 i
Describe the proposed business including use, number of employees, number of shifts, available parking spaces,,number of
C I
vehicles, and any additional informatiorLthat you can provide: e,d I G e
-.t1 l°\ i � M nnr
_ n j
*This Clearance will only be valid on the parcel for which it ' approved. If you c nge, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or hav 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 est y knowledge. I have read the"j ditions of approval, and I understand them, and that I will abide by them.
/0 j
Signature / Printed ^✓✓t. ;/
APPROVAL INFORMATION
'jK] 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 r Date
Zoning Official Date l zl z [7-))3
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
1`- 4;j_1
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Intake to complete the following:
Is
Is us n LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /n '
Wil ere 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 ublic water.
If private well, provide HealtTi Depa ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies--
Is parcel on septic r public se e!
Y
Wi you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y
Wi ere 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: z / ()
erm tted as: `t C S'S i` d
p � ce
Under Section: 910
�, I
Supplementary regulations section:
Parking formula:
Co,
Required spaces:
Y/N a
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/�
If so, List:
Proffers:
Y/
If so, ist:
Varian e:
Y /0
If so, List:
SP's:
Y /•
If so, List:
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, p Iejwv,�- 1'' ej1C4 -e , 0 D) V kS &— 6 —
i [(County application name and number] Ate,. lb
was provided to l�0 I ` j� `� �� the owner of record of Tax Map l Zi
[name(s) f the record owners of the parcel] l,�
and Parcel Number / �� 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]
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 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�pplibant
LCr�7 l
Print Applida& Name rr f
Date