HomeMy WebLinkAboutCLE201400032 Legacy Document 2014-03-10Application for Zoning Clearance
CLE# ?D I L
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ON
Check," Date: ?j,)qjj
Receipt #--qS-7A—%, Staff':
PARCEL INFORIMATIQN I
Tax Map and Parcel: S Existin(,7onin
Parcel olvuer:-5600eS CJ C)ovey- L.Q-,Y-) LZA
Lac L,,r-js�
Parcel Address: Y.D-Z-- City �1-v4b OL)Xo State V-A Zip
(include suite or floor)
PRIMARY CONTACT
Who should wecall/writeconcerning this Project"
Address-,: L-Qo-� City tate zi
-), -14 t&,fl
Office Phone: L 'A - Fa.v 9 E-mail
APPLICANT INFORMATION
Check any that apply: Change ofownership —Change ofuse L---than_cTof name New business
Business N amcffylie: �ocwi-c-+,,Q,, �
Previous BuMnesson this site C+
Describe the proposed business including use, number of Linplo-yees, number of shifts asailable PaAdugspaccs, number of
vehicles, and any additional information that you can provide: fj�j cep 54 ! �
"'this Clearanca gill ollIN tie valid ('31 the parcel flov iihicli it is approved. If %-oil cli.,uige, inteusify or move the to a nets location, a ne%% Zonniq
Clearance %N ill be requirml,
I hLreb% cenifv that I o"n or have the omlee, permission to Use the space indicated on Otis application. I also certify that the inforritation jxlwidW
is true and accurate to the b,3t off my knoidk-Jae. I have read the conditions of approval.. and 1 uadeTdand theni.and that I v, ill abide I-A- flicin.
Signature Printed Meq,,5LK J—a-c� a!�
APPROVAL INFORMATION
Approved as proposed Approved with conditions Denied
Racldloa prevention device andfor current test data needed for this site. Contact ACSA.97745II.xII7.
No pit ' ysical site inspection Itas been done for this clearance. Thcreforc. it is not a determination of compliance Nyitli the existing
Site Plan.
[ I This site complies with the site plan as of this date.
Not".
Building Offi,cial Date
Zonina Official Date /612 -c IV
U
Other Official Date
Count-,• of Albemarle Depaulment of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: •434) 24-5832 Fax- (434) 972-4126
Revised 7/lf2oll Pi,,,.c -) of
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/�-)
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 or�pil ►c water.
If private well, provide Healt t form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic orrublic sewe
Y/N
Will you be 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 #
17 +n nmm ln +n +hu fnllnwinv-
Reviewer to complete the following:
Square footage of Use: // "72^
Y) /N
Permitted as: 7 P- 4 /I (Q
�'-f �
Under Section:S 2
Supplementary regulations section:
Parking formula: /
Required spaces:
Y /
Items to be verified in the field:
Inspector:
Notes:
Date:
uvaaaaa
Violations:
Y/
If so, ►st:
Proffers:
�/N
so, List:
Varia ce:
Y/
If so, List:
SP's:
�/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
C-- -- -
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
orpner:
I certify that notice of the application, L
[County
,,applicati i name and number]
was provided to a11,y� �� a„ fA �?V. .1 4A4U the owner of record of Tax Map
Iname(s) of the rec1ord owners of the parcel]
and Parcel Number. �-7 S f ayrl e-� by delivering a copy of the application in the
manner identified below: p�0'.
Bard delivering a copy of the application to
[Name of 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 aWn—sL Az 5 rz • 40: 1. �+
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient ofthe record and the recipient's title or
office for that entity]
on a L.2 (P h to the following address:
Date
06 S c,> 177 CA&cLy -l6*S m Ao, VA- -� o Q
[address; written notice marled 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].
Signaturt4f Applicant
f'1'1 "I �9�✓l
Print. App cant anme
of
Date