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HomeMy WebLinkAboutCLE201300156 Legacy Document 2014-01-03Application for Zoning Clearance���z_ CLE # � `6 ° 109 at�OF AI.It�t k I /hY71N�P PLEASE REVIEW ALL 3 SHEETS OFFICE USjy Y`24 Check # (1 Date: Receipt # Staff: — PARCEL INFORMATION Tax Map and Parcel: 0310o- 00- 00- 01LIoG Existing Zoning C-1 S —yn cc%-\ Parcel Owner: D pp �/ \Ah)y c Parcel Address: ©18 �a \VSv ?)c� City State ✓A Zip z�136 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? C V)c:N 1O Address : P• o , ?2c-.,)c 20 cEl City. State ✓A Zip z2g36 Office Phone: �� Cell # h'3`�' "%62-3157 Fax # E -mail �h��p Gd ch�Mpl�ws=n- APPLICANT INFORMATION Check any that apply: Change of ownership Change of use New business Business Name /Type: Ghcm I�w 1-c�ds In i- a�clsc 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: L, �cn cis=A -Ira sAcc_- car-;Qr1=J+ I° E: Q cSs f�nG 5ljrrc� 5 wcsK -ic�G`r55 . % (� 1e c�CvC, '�'c worK cc..s\ Cede .✓-}ri S�ltmcc \SG.. *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 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 I will abide by them. Signature Printed (!L cnQ g) 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. �1,� �i/�} f el- .wl1--f - f 4 / /V Z=orvt a✓� [ ] This site complies with the site plan as of this date. ,�J Notes: l7 "- C)/►i�l/ %�� yP / erQ c c)k, Ln Building Official Date Zoning Official Date 7/�'�Ze� 3 Other Official Date County of Albemarle Department of community Deve►opmeni 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 ,..Revised 7/1/2011 Page 2 of 3 C, c Ma Intake to complete the following: Reviewer to complete the following: Y On Square footage of Use: Is LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / N Permitted as: Y /(0 Will there be food preparation? Under Section: If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Supplementary regulations section: Dept. FAX DATE Circle the on at p lies Parking formula: Is parcel o rivate reel r public water? Required spaces: If private we ,provide ealth Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Y/N Circle the one that applies Is parcel o septic public sewer? Items to be verified in the field: Y N ill you be putting up a new sign of any kind? If so, obtain proper Sign permi n n � Permit # �C/ Inspector : Date: Y N Notes: Will there be any new construction or renovations? If so, obtain he e o ��jj ermit. Permit # )�UJ Violations: Y/N If so, List: Proffers: Y/N If so, List: 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 (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, Zoc+�n G \mac [County application name and number] was provided to 1'� ;DQ the owner of record of Tax Map [name(s) of�cord owners of the parcel] and Parcel Number oatocv- c5c,- cc-,- oiycz>by delivering a copy of the application in the manner identified below: er Hand delivering a copy of the application to 1 ' [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 !!5A1111.3 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]. signatur of Applicant Print Applicant Name 6�/i3 Date I � l i l U LL �j �j r r l U LL �j �j