HomeMy WebLinkAboutCLE201400037 Legacy Document 2014-03-07Application for Zoning Clearance`''
CLE # 2 y � ,O /
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 5 7 Date:
Receipt # i Staff:
PARCEL INFORMATION
Zoning P D5G
Tax Map and Parcel: Existing
Parcel Owner: S'ECvkJA 9AK ►K ,e "i-TZLJf, 1
Parcel Address: 13?;0 PAP—JAA& Gj & City A4P- -��51( I L.C19tate JA. Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? M1►CE J ACS C,,, ,
_ / I )
Address : P 0. 8 ,yk 94o City gUT-A� C-iLsJ State VA Zip_ �`4 c,,
Office Phone: ( (v 2 -21? Cell # Fax # O - . -mail M v ,. u e
APPLICANT INFO PION
Check any that apply: Z of ownership Change of use Change of name New business
1Channge
Business Name /Type: (},M oll Ci �S T' AA ARKS= 8,84 k-_
Previous Business on this site _15 j LL_A P_ 0j..! jE' (-;AnI 1,
Describe the proposed business including use, number of employees, number of shift ,available parki g s aces, number of
vehi les, and any additional ninformation that yo, can p. vide: 1�i/ Q �C 1_pC_i� -i"t f fl INJ
t FT 1 ( L_AL
iCL e
*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 tha 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 accur t to th best of tyy knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature hl Printed
i
APPROVA INFORMATION
>4 Approved as opo e''d [ ] 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 A Date t �(
Zoning Official Date _3111 lio)�
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 use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
WilQtere 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 public water
If private well, provide Hea Depa� ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap ' s
Is parcel on septic o public sewer.
YEN
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit. .
Permit #
Y/N
Will Dbe 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: );t5
0/N
Permitted as: Z4 6L
Under Section: 2J�. 2-1
Supplementary regulations section:
Parking formula: ! D
Required spaces:
Y/N
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
Y/
If so
P`�'offers:
(/ /N
If so, List:
Variance-
Y/01
If so, List:
S� 's:
OY /N
If so, List:
Clearances:
SDP's
5i7P
�5 -35
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, L R M,A Lam- �1 M� 6C r-G-
[County applicat'ion pname and number]
was provided to [)hi lb ��T IIA Egl & � 0 �4wner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number b q [ DO— OD •- Q() - 09 0D 2-- 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 01,1 IK d.-OW,
[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 .3 /a��f to the following address: e` o
Date
kPi
A,:2 �=
[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].
S' nature of Applicant
Print Applicant Name
Date
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