HomeMy WebLinkAboutCLE201300288 Legacy Document 2013-12-09Application for Zoning Clearance
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CLE # � � ° 2
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OFFICE U N Y
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # O %) Staff:
PARCEL INFORMATION
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Tax Map and Parcel: 5°) b2, °" t? �-,�' Existing Zonin 1�1 1, ►� Jlp
Parcel Owner: n1VZ►'1-'1 DI" V ►r 1✓1►4 1-ph'viiifro
Parcel Address: �;3UCC'r'S -I�GtQ I� i S� f l o' City C ha0�Si�1 l Ie' State VA
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? V► I v I-iar ove MD
Address:-61(0 Rdo*-VV 0 o 64 City C'N crdDfkSVI I Ie State VA Zip22903
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Office Phone: K! A) 6 0 -363 Cell# 22 7ia9O Fax #U,?_'7$23 E -mail �Il��tl/r9�✓P�'1j11'1� ��
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: -
Previous Business on this site FV ►'vi ► Med ► cA "e, PL-U
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
information that can provide: M 00 S"bd Frim )1 y Pr-x& h C -e OPR C e-
vehicles, and any additional you
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*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
II have the of approval, and I understand them, and that I will abide by them.
is true and accurate to the best of my knowledge. read conditions
Signature e`er Printed L11,1 �' iQ �� �� �� ►�
APPROVAL IhFJRT,.AOON
`[>� 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 — 5- -
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Zoning Official , / Date
Other Official Date
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County 0I Alnemarle Lepanu►enL vi %,uuuuuiuUy ..-1—F........
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:
YO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/a
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
Is parcel on private well or public 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 applies
Is parcel on septic or public c sewer?
Y/0
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
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Reviewer to complete the following:
Square footage of Use: v5 6
Permitted as: I ►I� `W A ��/
AqUnder Section: a '-
Supplementary regulations section:
Parking formula: ^O Y)
Required spaces:
jIteb be verified in the field:
Inspector : -/ Date:
Notes:
uv as aaa
Vio i s:
Y N
Ifs st:
Prof s:
Y/N
If s ist:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
VQ
SDP's
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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 P-1 u 1 a �FJ'P)4 A 1-fi the owner of record of Tax Map
[name(s) of the"record owners of the parcel]
and Parcel Number 5O) P Z - 0 1 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].
;7.4. 1
Date
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