HomeMy WebLinkAboutCLE201400006 Legacy Document 2014-01-10Application for Zo ing Clearance
CLE # -241 y
,.
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # CILI O 744 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 690 Rkryl A% Q a -C LE . Existing Zoning
Parcel Owner: F Ate/
Parcel Address: Ur if 23A � -j om�) City ei-1 ARt-oiTGSytL1.6_ State Vi f�-G,I ►J r A Zip zag o�
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? �A (z>� 1 LL��N E r2
Address: (o9 p X G-P km62 Ci k C L E City C�{ a�RLti i ESv /1.1� State VA Zip,)-a-9 0
Office Phone: 1 395 Cell # -60-55 1-9a-3 Fax # u3ti -`f 33- Doi3E -mail +rogIpe rs 123 J ,4yk,&+ �•
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
'
Business Name /Type: p2 rry,S-f ,-C ?j,a-ce-(ne y1 Sir �,�1 L� S s l m %-�S J-[,+5 c&, -0-Y, <- .
Previous Business on this siteS�
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: t �' �y.m �e Z na na-e e- r %�rn21 s
," c£c� LQ li (e arl��
m
*This Cleary ice wil my 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.
1 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
my knowledge. I have read the conditions of approval, and I understand the, and that I will abide by them.
is true and accurate to the best of m
of
Signature 4YZI ,iCi��= , Printed '-rAP, A I LLZ-,N Ee
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
13ackflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, xi 17.
[ ] 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 j 7 I t y
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 7/1/201 1 Page 2 of 3
14 G
VMFQVI
Intake to complete the following:
MOM
Is use in LI, 1 -11 or PD1P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y 'U ..
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 public water?
If private well, provide Hea
rne11tfC rm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that al) 'es
Is parcel on septic r public sewer?
Y
Wil you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
W ill t sere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 133
Permitted as: (� 1'►
Under Section: 2 �<
Supplementary regulations section:
Parking formula:
Required spaces:
Item to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /(N)
If s6,-Li st:
Proffers:
Y
If so, List:
Variance:
Y /, -N?
I l'so, List:
SP's: \\
Y
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 fora rust accompany zoning applications (Hone Occupation, Zoning Clearance, Zoning
Atlnin.istrator Determinations or Appeals, Sign. Permits, Building Permits) if the application is not the
owner.
1 certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
Hand delivering 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]
Oil
Date
Mailing a copy of the application to
[Name of the record owner if the record ovmcr 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]
Oil
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].
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