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HomeMy WebLinkAboutCLE201300012 Legacy Document 2014-01-02P D, -1rnE 1, ilia A1, Q nfY)A .M4 ,N6 Application for Zoning Clearance CLE # 2,0 0 " 12 OFFICE U5 ONLY G PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt #9,,A (14-t— Staff: rn VPF � PARCEL INFORMATION /�IGJ WB>'� Existing Zoning Tax Map and Parcel: Parcel Owner: loM �W dj � � /1)1104 Parcel Address: V �iU&W A#&ANVY City CIWall4sy%l1, State 10 Zip 2 90 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address �d 101/!f� Cit Y 11.84© kTjV1GL2rState V,4 Zip 7 2/03 Office Phone: Cell #Y%0id9,4JW 0 / Fax #7473 779;7109Y E -mail 4A11)iA?4d W1 e-0W APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business PLC Aq'� 'Pawllly Business Name /Type: Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of /,(/N'��NVTiS%4%��', /5- E/iJ`'6����5 X511115 s, vehicles, and any additional information that you can provide: l 0 Nk I- Fob' s.1or1� A, 6; � (/74Y -' *This Clearance will only be valid on the parcel for which it is proved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. Ze is o o use the space indicated on this application. I also certify that the information provided is true and accurate to the best h read the conditions of approval, and I understand them, and that I will abide by them. I hereby certify that I own or hW'.R�g Signature Printed APPROVAL J FORMATION ] 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 Zoning Official Date,��2 /d���% Other Official Date County of Albemarle impartment of uommumiy LIUMUpu►euL 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/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/N 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 sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit# Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit# 150 ACI 7nnina to emmnh -fP. the fnllnwlnor: Reviewer to complete the following: Square footage of Use: 17 LJD O / N _ Permitted as: c.1-A,v,t e- SGT r"`�e Under Section: Supplementary regulations section: Parking formula: / • ��J Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y / -A If so, st: Proffers: [ /N If so, List: Variance: Y/(DV If so, List: SP's: �/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 (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 ,flip ra Pt;11tl?j ljl�; — NIVAI ffn1 the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number W-/10 by delivering a copy of the application in the manner identified below: X Hand delivering a copy of the application to Iflayyo law/ Gl G _ 11100 4(20 [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 �y ITi 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 [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 ai Date