HomeMy WebLinkAboutCLE201300304 Legacy Document 2014-01-065 �wG f-}-
Application for Zoning Clearance1�r/
CLE # Zo ('S - sa
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check# 12.
,
PARCEL INFORMATION
Tax Map and Parcel: 2 "' 26 13 Existing Zoning
Parcel Owner:✓ diTeS'l�l- ({ CJ d C_.Om aIQN
Parcel Address: Z�rS/ city we Zip z S,9 IN
(inc ude suite o floor)
PRIMARY CONTACT
Who should we call /write concerning this project? AdMx s wv �/2
9, Cityy C AA O �•�'� 1�/5+t a Zip Z L 90
Address -f1f✓
Office Phone: ( J�Acell # ���fbS "�!f /r'ax# E -mail AJ QVAi i rWA!L-
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name -New business
Business Name /Type: Al SJ E kAi Al 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: pe i h4a Gfi1:" -
*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. ave read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed 7_4 D1Z
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.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official _ c Date �— t
Zoning Official " Date
Other Official Date
County of Albemarle Department of Community DevewpineiiL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
P
q"
Intake to complete the following:
Y
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
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 o ;ublic water? If private well, provide Healt partment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that a
Is parcel on septic o ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit# 7 Y Fijy"N
Y/
Will (Pre ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nninrr +n nmmninfP the fnllnwina-
Reviewer to complete the following:
Square footage of Use: PC->
(9/ N
Permitted as: A,a�k> V c/
Under Section: 2 �.
Supplementary regulations section:
Parking formula: 1
Required spaces:
Y / LN
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
If o4ist:
Proffers:
Y/
If so, ist:
Varian e:
Y/ i
If so, List:
SP's:
Y/
If so, ist:
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 the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
by delivering a copy of the application in the
[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
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].
Signature of Applicai
Print Applicant Name
121;x// 3
Date