HomeMy WebLinkAboutCLE201300293 Legacy Document 2014-01-15Application for Zoning Clearance�t;,r�'�1;
11KIIN�
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE 0p�L'Y l
Check # 00 G. Date: `
# Staff: RIM
Receipt
PARCEL INFORMATION, • ,� �r���(�
2 � Existing Zoning, i' (.t �
Tax Map and Pa reel; ~ .
Parcel Owner;
$ �mtool It�.t City r State Zip�L`��i
ParcolAddress; I
• (include suite or floor)
PRIMARY CONTACT
042V
Who should we ealllwrite concerning this project ?� Y ( OM ot)&Z.
tH"j
Address :313q Zip aRl
(y�aE
Office Phone: (�) Cell # YC}cl• -`lG5R Fax# E -mail Wi43Ck m 1j 0q e9 ma; i•eC
APPLICANT INFORMATION
Cheelt any that apply: Change of ownership Change of use Change of name business
j�v
BusinessNome/Type: q� CaY6oQ (�U K S'C--rv1Ca �L'S�GtU'rGiY�T
Previous Business on this site W& M t Asin n b t s4 qy
Describe the proposed business including use, number of employees, number of sliifts, available arldng spaces, number of
a• V e- C le
vehicles, and any additional information that you can provide: err° ?(bu
only be valid on the parcel for which It is approved, Ifyou ge, lntenslfy or move the use to a now location, a new Zoning
*This Clearance will chan
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 ccrtify 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'M lt abide by them.
Slgnafuro tlrrinrr�y Printcd l�iti~' -tAM A"� rnar.)
APPROVAL INFORMATION
Approved as proposed j J Approved with conditions [ ] Denied
[ j Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ J No physical site inspection has been done for this clearance, Therefore, it is not a determination of compliance «dth the existing
site plan.
{ J This site complies with the site plan as ofthis date.
Notes; -
Building Official Date
Date
ZoniugOfficfal a
l a 1
Other Official f l VP Date Pi � z+
County of Albemarle Department or UommtuuLy weveiol,mcnL
401 McIntire Road Charlottesville, VA 22902 Voice; (434) 296-5832 Fax: (434) 972.4126
M
Revised 7/112011 Page 2 of 3 ,
Intake to complete the following:
Y /0
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
N
dill 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 orjublir c 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 o �ewer?
Y/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y N
drill there be any new construction or renovations?
If so, obtai ro er,Permit. `p
Permit #
n _ _ ;a I —A
Z ' to com lete the followin
Reviewer to complete the following:
Square footage of Use: / �Z- 9(i
t,l/N l // ,
Permitted as: Perri ^�1 1157A�/ - fh1ll_ ''e
Under Section: Z 2 • /
Supplementary regulations section:
Parking formula: S�
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
n
om
Violations:
Y/
If so, ist:
Proff s:
Y/
If so, ist:
Variance:
Y
If soPLIst:
SP's: l
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;
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
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].
Signa re of Applicant
Print Applicant Name
Date
?Ire,
C� vo
C7)
Ch u, r ro,
ryl C1 c In i ne,
}--1)
C4, C\ r C On
w 1 ch
?Ire,
,T) -o SA-Orct�t
I
C� vo
,T) -o SA-Orct�t
I