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HomeMy WebLinkAboutCLE201300295 Legacy Document 2013-12-19Application for Zoning Clearance CLE # PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # Cg_-�A Date: Receipt # Staff: %A PARCEL INFORMA IO �, � c Tal(1�yp y�%e I OL1500- (w-oo- I0lA`ExistingZoning C c k"-Ine ,-CIG Tax Map and Parcel: ce,(- Parcel Owner: T2vdcI yr fy p,'S e 5 L C L Zip Parcel Address: '7 le —;Je_ Tan , �,414tj ity // uI Syill e _State V (include suite or floor) PRIMARY CONTACT I o A —( AA )a ad h Who should we call /write concerning this project? I 1 '907 �ehrrv�C' Trail. ! 204.E City (Jin1 Refi/el, State Zip Address: uU4e Office Phone:( 3q ) e1���3�� Cell # Fax # E -mail G�uY, Wu�soH ��['abe i�+i APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Changye� of ✓ New business name �roY1 ���ti�,OA ✓''I G' +� 1 ' LL C Business Name/Type:;32111111114# /dr Previous Business on this site Describe the proposed business including use, number of employee nu be of shifts, av ilable parking spaces, number of ;b � 13 pz!nFF6o 1sl.��'� vf�hicl�s ,1a ndd y additional in ormation that you can provide: �t ev,Jop cj !e ST `6Up��i� *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 th wner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to th est of m o I ge. I have read the conditions of approval, and I understand them, and that I will abide by them. AA `)pli,50-1 Signature Printed ki 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 (o t `� Zoning Official Date Other Official Date County of AiDemarie Department o► %.viuu►wuLy ,JGVV,VY1,,-..- 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 oG4�t AN Intake to complete the following: Y / O Is use in LI, I -11 or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wiil 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 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 or blic sewer? Y Willy be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y N Wil rre be any new construction or renovations? If so, obtain the proper Permit. Permit # ry .. +n nn --Ia +a +ha fnUnwina- Reviewer to complete the following: Square footage of Use: q' / N r) Permitted as: c.� Under Section: Supplementary regulations section: Parking formula: / Required spaces: Y/ Item to be verified in the field: Inspector : Date: Notes: LJVll 1Air, 4V �. Violations: YIN If so,Yist: Proffers: Y/N If so, ist: Variance: Y IN f so, List: Lm SP's: IN f so, List: f� J Clearances: SDP's -- 3 914)- qSl Revised 7/1/2011 Page 3 of 3 is 217 -1 att llw_ M, � M, co I 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 tlae application is not the owner. I certify that notice of the application, [County application name and number] was provided to (\ J "-fp-(twje;,U C the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 6 900. -oo-oo ` MAC) 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 t' tr+nl er rt�S�4 Ucl [Nam6 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 Po C3ox C 7:(g , C� ail g#c4 y;11e, Vag Z.-Zcf ©C [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]. OD _a Signat e of Applicant ua,,- r 04 Print Applicant Name 121/12 / L 3 Date