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Home My WebLink AboutCLE201300003 Legacy Document 2014-01-02r , Application for Zoning Clearance ``,:^ m1. CLE# 2,b1J � -�_� ,�� ' OFFICE E LY PLEASE REVIEW ALL 3 SHEETS Check # Date. l Receipt # Staff: 1 PARCELINFORMA�j�I -ON r Existing Zoning CJ- ��SYYifY f6 Tax Map and Parcel: 't 1�'i� 1 �.,' 7G=c` Parcel Owner: r Zip 2�'C`/ fUl �14AC- j�1�'n Parcel Address: ., (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address l0C) (c-A e rJ"g P J U,. 'W' liN00 Zip _1MG Office Phone: L—) Cell # �3�'Z'(�' pax # E -mail _ APPLICANT INFO Check any that apply :.. TION Change of ownership Change of use Change of name New business Business Name /Type: ' 0 Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of l vehicles, and any additional information that you can provide: Fg) r,A 5 LeAj'4 c e8 .s / ^ n n A *This Clearance will only be valid Ion 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 is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that *will abide by them. -41 */ Printed �f!�%UU Signature ;r. U4 APPROVAL INFORMATION Denied [ ] Approved as proposed [ ] Approved with conditions [ ] [ J 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 Zoning Official 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/Q Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/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 DA'T'E Circle the one that applies Is parcel on private well or pu lie water? If private well, provide Health nt form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that app s Is parcel on septic o ublDsewer? Y /NO 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 # Reviewer to complete thej following: Square footage of Use: \ 1 t Pr S I UJY-0 N ermitted as: S�� (1 ) t Yl_'1 Under Section: L] Supplementary regulations section: Parking formula: Required spaces: Y/ ) Item�o be verified in the field: Viol ns: Y/� If so, List: Proffers: Y/ If so, List: Vari Y/ • If so, ist: SP's: r Y / 1 Q If so, List: Clearances: SDP's a6 a' aWi Ir 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; [County application name and number] was provided to eg, d �� B� GG the owner of record of Tax Map [name(s) of the record owrrers 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 �rhe [Name of the record owner if 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 to the following address: Date Ice, [address; written notice mailed to the owner at the last known address of the owner as snown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signatu of A licant n j 0, V Print Applicant Name �� Date i n ir. u r' G „r 4 y /V gV cald, 4VJQO •�T Application for Zoning Clearance p: CLE.# PLEASE REVIEW ALL 3 SHEETS Check # Date: Recelpt Staff: PARCEL INFORWA I0 N2 Tax Nlap and Existing Zoning l Parcel: `:J Parcel Owner: �-vl Zip Z 2q-01 Parcel Address:_ . ........ --.- ....(Include suite or.floor)..... PRIMARY CONTACT 5(� I/QY Who should we call /write concerning this IV,( project? Address �Q0 at`tlt Vt City �thlzJv'�(�tate �% i�C_ ZIp 2 AGO off-ice Phone: L__) Cell # u�� Z P, # _E-mail •. APPLICANT INFORMATION Check any that apply: Change of ownership' Change of use Change_of name - ^;__ :New business Business Name/Type: O Previous Business on this site Describe the proposed business including use, nuruber of employees, number of shifts, available parldng spaces, number of vehicles, and any additional information that you can provide: �•,_. ._ �.r�rt An.t _ is Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move {he use to a new location, anew Zoning Clearance will be required. I hereby certify that I vmi or have 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 best of my knowledge. I have read the conditions of approval, and I understand them, and that `will abide by them. Signature ,4 I Printed ' - APPVAL INFORMATION [ J Denied [ RO ] Approved as proposed [ J Approved with conditions [..J. BacUo vw.preventlondeviceatld /or, current, test.data_neededforthissite. Contact ACSA, 977-4511, x1 17. [ J No physical site inspection has been done for this clearance, Therefore, it'is not a delermirtatibn of compliance with the existing site plan, [ ] This site complies vitli the site plan as of this date.' Notes: Building Official` Date Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fix: (434) 9724126 Revised 7/1/201] Page 2 of3