HomeMy WebLinkAboutCLE201400005 Legacy Document 2014-01-10Application for Zoning Clearance
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # 2--%7_0 Date: 1 4 1
Receipt # Staff:
PARCEL I1ITFORTION
Tax Map and Parrei: �'�ri��cy0 GD r✓ g `-!` Fo Existing Zoning 00M w-p oe l`-
IVY" co N/VIa
Parcel Owner:
ParrelAddress: P% // (> ..� ��% �Uf`�U�J City 4Wk--7:IVYState k/k p �Z-
(include suite orflooz)
PRIMARYCONTACT
Who r��+
should ive callhvrite concerning this project? V — �✓V����L
Address: lz9Gi0
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Office Phone: (_) Cell�s3
_Fax# E -mail b %Ace vr5,$ 62 66
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: —Ih n er 5 a n C461 VVI i I L LC,
Previous Business on this site %nor Vwd, -% &lC-P�eeC� f C'Ctc pGccn �7 T ,
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, numberof
vehicles, and y additional information that you can provide: • ( cti�i l� 7 , 'o � r.3h
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*This Clearanc will oni be valid on the parcel for which it is approve . Ifyou change! intensify mote the use to a new location, anew Zonis
Clearance -;ill 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 t-m and accixiate to the best ofmy kno ae. I have read the conditions ofapproval and I understand them, and that I -will abide by them.
Signature <c` Printed
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Dackflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] No physical site inspectionhas been done for this clearance. Therefore, it is not a determination ofconTliance with the existing
site plan
[ ] This site complies with the site plan as ofthis date.
Notes:
Building Official Date
Zoning Official Date /
m
Other Official Date
L;ouuiy or Aiuemazte Department Of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/10-_011 Page 2 of3
A"
Intake to complete the following:
Is use inLI, HI orPDIP zoning? Ifso, give applicanta Certified
Engineer's Report (CER) packet.
Y/N
W re be rood preparation?
Ifso, give applicant a HealthDepartrrent fonn
Zoning review cannot beginuntilwe receive approvalfromHealth
Dept. FAX DATE
Circle the one that applies
Is parcel on private siell F56blic Eh�t
Ifprivate well, provide He form
Zon ing review cannot begin untilwe receive approvalfromHealth
Dept. FAX DATE
Circle the o t applies
Is parcel septic or public sewer4
Y/N
Will you be putting up anew sign of any kind? Ifso, obtain proper
Sign permit.
Permit # La. �& r o
Y/N
Will there be any new constriction or renovations?
Ifso, obtain the p�operPennit.
Permit # - r O 1(1
Zoning to c0imlete the following:
Reviewer to con4Aete the following:
Square footage ofUse • �1
Permitted as: p
Under Section: -;-y • L
Suppleinantayregulations section:
Parking fonrrrla:
Required spaces: ll/
Y /
ItenaVto be verified inthe field:
Inspector
Notes:
Date:
Violations:
Y /0
Ifso, ist:
Proffers:
Y /
Ifso. ist:
Variance:
Y s Ist• �
If
SP's'-
y
Ifso, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form roust accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Adirtinistrator Deterrreinations or Appeals, Sign Permits, Building Permits) ifthe application is not the
owner:
I cert ify that notice of the application, �,pliC� -b- r� --63 R Zyn� r � C21 e." ra v,G�
[Coumty application narnethd nun ber]
was provided to :TV% 00" M,0)1 51 LLC , the owner ofrecord ofTax Map
[name(s) of the record owners of the parcel]
and parcelNumber U 5 Ft, 66-oo 4tE1?y delivering a copyofthe application inthe
rmm -ier identified below:
Hand delivering a copy ofthe application to C-�-
[Nance of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipi ent of the record and the reci pi ent' s
title or office for thaat entity] /�� �� � d'F , Z"" f9l's
on. L.,
D Ve
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 ofthe owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
S' tur ?Applicant
Print Applicant Parm
Date
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