HomeMy WebLinkAboutCLE201400017 Legacy Document 2014-02-03Application for Zoning Clearance
CLE # � 14- - 0
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OFFICE USJE ONLY
IIM05 i -N -14
PLEASE REVIEW ALL 3 SHEETS
Check# Date:
Receipt # q A!�DO Staff: vnn4C ,,,
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning
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Parcel Owner: 1k�o,kb
Parcel Address: C� �� 22n���`2� pl y City Ea 1(6 State V 1T Zi�
(include suite or floor)
PRIMARY CONTACT
b eAS
Who should concerning this plrroject? � NO-
�wee�call/write
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Address: L`C D C�2`QV�VJ�� e� k0ce City \ 0 l State Zi q0
Office Phone: (!A 06(;5. Cell # r? Fax # % 5Z E -mail rn"b 0001• (low
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: �m� 1 , v\ bd J(� W e4" c , I—L('
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Previous Business on this site kos G eP sn
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: `crn b C'Lt ar,&
r V < V
*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 my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed��
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 Date
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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y/N
Is us LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y /
Will e e 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 r public water?
If private well, provide Hea epar ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap plies
Is parcel on septic public sewer?
Y/
Will ou be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y/N
Wil ere 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: 1110
6 1 N n�
Permitted as: 6 f ► C��
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y /0
If so, List:
Proffers:
Y I ITT
If so, List:
Varian e:
Y /El
If so, List:
SP's:
61N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
Thisform 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,
( p / [County application name and number]
was provided to (`7'i �_ 4" plp ��� �1° l� N)fjU_0_ the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number In I VV _1— P6 by delivering a copy of the application in the
manner identified below:
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]
on
Date C �'
1'1/1
Mailing a copy of the application to � UV
[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 _ 7aV� • �� to the following address:
Date
n3L-:) df &rck PA �qt�x
[address; written no ice mailed to t owner at he last known address of 1he owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of A plicant
Al
Ax eel
Print Applicant Name
Date