HomeMy WebLinkAboutCLE201300300 Legacy Document 2013-12-31Application for Zoning Clearance
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CLE# Z.a13 -30 D
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 10-L—( Date: %-2_/Zk h 3
Receipt # G1 4 a 0S Staff: X)
PARCEL INFORMATION
Tax Map and Parcel: ( oJ -- r > 1 " ' 11 & ':) Existing Zoning_
Parcel Owner: GrL.t?'�"r. e r .Sa , h6' LLC- ko-+ Sa 1 rl 1 Sy,' /%
Parcel Address: g( G ye` ey\6,•, P,(- City a v ACS _ us 1I State V Zip a
(include suite or floor)
PRIMARY CONTACT
3 br)
Who should we call/write concerning this project? e,vt V1 r— 1A Ie�
Address : 3 ?�(_o r-, f t P,�- _b(- - A City Cjc rl.6+" fz5V t //State VA Zip 'zagn 1
Office Phone: C46V
)Q0Q - fi&M Cell # Fax # — — E-mail —�° ,�r.P s 4-a a
Cot
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name 1/ New business
Business Name /Type: T Gr a
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: 0, v,1 ; ( 1 p Cy
c) v�.e , S 1' ° =F I- 9 Ahl - 10 9` 16 4- V _Ll_ f 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 the owne, permission to use the space indicated on this application. I also certify that the information provided
is hue and ac to to the best of my owle e. I have re d the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed__
APP VAL INFORMATION
[1,4 Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bac ow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x117.
[LJ o 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 /Q Date `�-
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:
Y �. J
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wil re 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 public water?
If private well, provide Hea -Dep ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a
Is parcel on septic r pub
Y /�
Will you be putting up anew sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /(N J
Wil 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:
Q/N tted as: U
c r � lrol,
rmi 1
Under Section: (�' ` - 1 `,Co,
Supplementary regulations section:
ii��,crL�ffi
Parking formula: l
jrn
Required spaces:
Y/N
Items to be verified in the field:
1
a.
Inspector : Date:
Notes:
Vio s:
Y _
Ifs , ist:
Pro er
Y /N.
If so, ist:
Vari
If sol'List:
SS
If`so List:
firnak
Clearances:
SDP's
s) 1y1,,
Revised 7/1/2011 Page 3 of 3
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386 -A Greenbrier Drive
Greenbrier Square
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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 Cc e e tow c-',N r SG k,&c . L — (- the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
Hand delivering a copy of the application to in ,v r SCi 1k�---Q." �L
[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 I A 13 0 1
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].
Print Applicant Name
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