HomeMy WebLinkAboutCLE201300262 Legacy Document 2013-12-31ra:L'-•
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FF-a r�p�IacatYOr� f .�Zing Ct lca.rar�c� �,•`�•:
CLE #
0�'Frc>; u Nr,y
LEA5E- RE- Y- LE- W- AJ_,3_SH.Ei-T -S - Check•#— _.. Date:
_ _ Receipt. /�. Staff:
iNi<ORMATi{�� _ =-� f,� « n j n �II� r'� nd Pareel: (Xf) UQ/► 4 i-1 —tom D�isting Zoning ner: Altim4,rtt QiaCe_ EW ULC
ress: 7 f} -0 �y� �� A [ (� City G�+c r� ai�P�t); ��t? State VA Zip (Include suite or floor) Y CONTACT
tive callAvrite concerning this project? . C�.c�rlt;e {ar,r4
Address-' TZdd t,J AJ2r..:2 `t400city X�c:ilQSdet State zip Z(JWfit
Office Phone: ?ol 3�i I- 3 ° {�� Cell i# titd 35'; 6 G Fax# d1�f. Z' 3S. i;.mai1_G5 jC t -A -t (cJ 2d2nS' Coif
-n k' W •, ;1A=r, a 17A •,u Y r vtclvil J'JL V lr -
Check any that apply: C Change of ownership Change of use , Change of name New business
Biislncssil fime%T�j h__ T CtM; ttJ s�S' JV P%p$
Previous Business on this site NIX
;E
' This Clearance %Hill only be valid on the parcel for which it is approved. If you change, intensiiyor move the use to a new location, a ne% %, Zoning
Clearance will be required,
1 hereby certify that I own or hdvc the oWnefs permission to usa the space indicated on this application. i also certify that the information provided
Is-true and accurate lot best army;&,\ \btvlledge. I hove rgad ilia conditions of apptovai,:and I understand them, anti that i %vill abide by them.
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Sigriptfi'n 7 L ( P�jitci3i' z L 7T i~ �'i t }
_r
AP ROVAL INFORMATION %
Approved as proposed [ J Approved with conditions [ } Denied '
[ } Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977-4511, x l 17.
[ } No physical site inspection has been done foe 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
Zoning Official — 1-mv
Other Official
Date t' I'
County of°Alrlemarte Depai ra6f of Community Develop ent
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972.4126
Revisdd 7/1/2011 Page 2 of 3
Intake to complete the following:
Y /
Is us LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
�
N
ill 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 applCalth
Is parcel on private wes water?
If private well, provide partment form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or X ublic sewer?
Y/N
ill you be putting up a new sign of any kind?
Sign permit. Nab
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the pro er Permit.
Permit # - 6 19,
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: 00
Eermitted as: Mu O 1 t' f 1 ►Ir
Under Section: ab. A --
Supplementary regulations section:
Parking formula:
Required spaces: V 'i \ v
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/N
If so, List:
QY ffer s:
/N
o, List: p^� (� ( �\
V l�1%1-
Variance:
Y/N
If so, List:
SP's:
Y/N
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 (Horne 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 M e tawi e Place F,A A p LL C 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 copy of the application to Ckckrlie S�PLAar+ r i,e sw,,, ASSot✓!ale , WgAj5
[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] 41. et L-le
on 11 11,11 k3 Parce C-AAP I
Date Inc
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 to the following address:
Date
[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
Pri nt App I i cant Name `
Date