HomeMy WebLinkAboutCLE201400042 Legacy Document 2014-03-27Anplication for Zoning -Clearance
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PARCEL INF ORMATION q � -t3�, �a ot7 15WXUAI- C-ft"k I
TO Map and Parcel: •t ~0 ' Existing Zoning
Parcel Owner: I\fvcf
Parcel Address:_ `i i i l (�U I�b City
(include suite or floor)
PRIMARY CONTACT i�
Who should we call/write concerning this project? V� / Q�
1. 04A 5 E � i Q� Stn #e V ET y Zip .
Address : City
Office Phone:
2"Y Q Cell # QZS i `'1D Eax # E -mail V4T
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of ase Change of naine gK Neiv business
Business Name/Type:
k Al 'S 000A r KA"-e--- Ce -fr�s�
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Previous Business on this slte. KYn���
Describe the proposed business including use, number of employees, number of shifts, avaflablerparking spaces, number of
vehicles, and ny additional information that ou can provide: '
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*This Clearance �vfll Daly be valid on the parcel for which it is appred. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that/ own or have the oimees permission to-use the space indicated on this application. I also certify that the information provided
is true and accurate to the best y kno e' e. ,I have read the conditions of approval, and I understand them, and that 1 will abide by them,
Signature �� /� %-. Printed }'�' i.0
APPROVAL INF9W&kT1ON Denied
[ l Approved as proposed [• ] Approved with conditions l
[ ] Backffow prevention device and/or current test data needed for this site. Contact ACSA, 977. -4511, x117.
[ ] No pitysiaal site inspection has been done for this clearance. Therefdre, It is not a determination.of compliance with the existing
site plan. '
This site complies with the site plan as of this date.
Notes:
Bullding Official
Zoning Official
Other Official
Date
Date z L
Date
County of Albemarle Department of Comm Development
4011VIcIntire Road Charlottesville, VA 22902 Voice: (43Q) unity ?G -5832 Pax: (Q3Q) 972 -4126
2
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Revised 7/1 /2011 Paget of 3
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Intake to complete the following;
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Y x
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Englneer's Report (CER) packet.
Reviewer to complete the follo-wing'.
.
Square footage of Use: l ��
N
mittedas: AAJ
Y N
ill there be food preparation?
Under Section: Z2. 7
If so, give applicant a Health Department form,
Zoning review can not begin until we receive approval from Health
Supplementary regulations section:
Dept. FAX DATE
Circle the on a4 Plies
Is parcel on rivate well r public water?
If private we} , rout a Health Department form,
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the oljle4h t applies
Is parcel o • septic or public sewer?
Parking formula: I�q,
Required spaces:.
2--
Y /N'
Items to be verified in the field:
1 you be putting up a new sign of any kind? If so, obtain proper
P ilN
Sign permit.
Permit #
Inspector : Date:
Wi any new constriction or renovations?
Y zle'be
If so, obtain the pro er Permit.
Motes:
SDP's 210
Permit #
LonIng TO Wrrl MM WC 1UHUrru1 I
Violations:
If
If / `L .
Proffje�TS.
If so, Syt:
Varia ce:
Y /�1
If so, List:
J/N
Ifso, List, ^, Z
Clenrances:
SDP's 210
Revised 7 /1 /2o1I Page•3 of3
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4
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form roust accompany zoning applications (Home occupation, Zoning. Clearance, Zoning
A rintlnistratorDetertttinatloits orAppeals, Sign Permits, X3r4lrlingPerntitsj if the 'application is riot tffe
owner, �
• �y �'r I�� �..�tG6C t� t:.t.. l
I certify that notice of the application,.
[County applicatio A ame and number]
i
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number • d q J6 6 ` 00- 6o " '00oe by delivering a copy of the application in the
tnann identified below;
Hand delivering a copy of the application to
We ( vher
[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 Ijtf
Date i
Mailing a copy of the application to
[Name of the record owner ifthe record owner is a persons
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 1 to the following address;
Date
[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].
Signature of Applicant j
Print Applicant N me
Date
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