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HomeMy WebLinkAboutCLE201400036 Legacy Document 2014-03-07Application for Zoning Clearance -►� "�u'��< CLE# 2.6Jq —3(::, 'x OFFICE USE ONLY Check # VTS Date: 3 PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMAjTION n Tax Map and Parcel: (T�/XC�10 '-DO :- ! AO Existing Zoning Parcel Owner: L- AA_%1;F9s a ,AAPA6Jq QE khl�611 I A Parcel Address: A J Qt tE d— bR . City State Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? kA 1AP Q�\ �4c) City V State ,, A- Zip 22 4 Address : , D, k Office Phone: ( 3Z- 217 Cell # Fax #k - 3') E -mail u6sk. Conn— _J APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: Q ynn G &"'T AA &916= 4�3 — Previous Business on this site � ,5 U_A& ,© J a &6C Describe the proposed business including use, number of employees, number of shift ,available par •ng paces number of vehicles, and any additional i formation th t you ca provide RJR D V lL� t� �5 ° o c '1 S J 1 Q L'C'S *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 th 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 accur o t t b) st of my kn wled e. I have read the conditions of approval, and 1 understand them, and that I will abide by them. Signature Printed INFO ATION �PPROVA 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 _-11 6/Zr1%V 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 Is D-il, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y �� Wil ifiere 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 or public water? , If private well, provide Hea IrDepar 'tform. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one thaw l' Is parcel on septic public sewer? putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / N Will there 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: 5 D Permitted as:A Under Section: 2 2 Supplementary regulations section: Parking formula: Required spaces: , Y/ Items to be verified in the field: Inspector : Date: Notes: Viola ons: Y/Y If so, ist: Proffers: Y/� If so, ist: Varia ce: Y /0) If so, List: SP's: N f so, List: Clearances: SDP's S. o(—(l 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, gL &Ml C- 00 ao j f A�p oL [County application name and number] was provided to �n, Q� —I Wile& �J agthe owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 04D0 — 00 /pv — I 1 U 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 Mailing a copy of the application to L)t j j 7 nj Q�IE MA&�gE 1 425 r4 . [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] onI�'� f� (� to the following address: r Date f �� qL� 1 VA ZZ5 Ajjw° ; KI lCE�- _.YC4�- [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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