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HomeMy WebLinkAboutCLE201400048 Legacy Document 2014-03-27lY-)-Mff 1, for Zoning Clearance ,Application CLE # 2-01 y 14 11 OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # 31 V Date: Staff: Receipt # PARCEL INFORMATION ®— ©Q'Z- DEl;ng Zoning C) Tax Map and Parcel: , _5-1,t2 _5-1,t2 _ Parcel Owner: 3 0 7 W- 140 A-0 t4 0 City (�.�T/NLGI�' ✓�Sfate Zip Parcel Address: (include suite or floor) PRIMARY CONTACT -_r– /;J, WV j- Larry Whitlock, Agent StateFarm. 325 Four Leaf Lane, STE 7 ®;;; _ City State Zip Charlottesville, VA 22903 r I — 1-� 7 � �Emai1 Bus 434 - 971 -9966 Fax# Tarry .whitlock.bwg0 @statefarm.com APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: L401A,157s✓L� ✓)I -4"t/k//4, VW C K _ 57-4 -T tC.7fm-I-L, 9:7—A/ 5; Previous Business on this site ^"'C-4 %a L— <f'l-) zt-nle L—j -'r e, CJ-0, 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: ti *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 f my knowledge�Ilhiavve read the conditions of approval, and I understand them, and that 1 will abide by them. Printed'^f^� Signa a vv ✓.�—f� c.��cc APPRO FORMATION 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. • I [� ] 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 or community Deveropment 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of Intake to complete the following: Y/0 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wil 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 o public water? If private well, provide Hea a en form. Zoning review can not begin until we receive approval from Health Dept, FAX DATE Circle the one that appl' Is parcel on septic o ublic sewer? Y,} N 'VVill you be putting up a new sign of any kind? If so, obtain proper Sign permit. 5)4"w �. Permit # wj� Y /0 Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonin to com lete the followin Reviewer to complete the following: Square footage of Use: 9 /N. Permitted as: �i Ce1 Under Section: 2 Supplementary regulations section: Parking formula: iZ' D J Required spaces: Y/ Items4d be verified in the field: Inspector : Date: Notes: Violations: Y%O If so, List: Proffers: Y0 /N If so, List: Va[ 1 g e:Nist: Y / If so, List: I' If s Clearances: SDP's Revised 7/1/2011 Page 3 of 3 0 e Y Pnz #105 1690.4 S.F. J oyv 5 #106 737.8 S.F. Larry Whitlock, Agent 325 Four Leaf Lane, STE 7 Charlottesville, VA 22903 Bus 434 - 971 -9966 larry.whitlock.bwgo@statefarm.com StateFarm • • • ,M o n ' 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, [County application name and number] 7 was provided to-J �o C L' VO't' � vW ° the owner of record of Tax Map [nam (s) of the record owners of the parcel] and Parcel Number 6.5✓& l�1 �� a ' 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 . �tiv �j �/A' Mailing 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 o t e record and the recipient's title or office for that entity] on .5 -Z-I — to the following address: Date 7 kJ, /2-,- o 12o #,\C) --F - / � J �__ r [address; written notice mailed to the owner at the last known address of the owner as- hown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signatur pplicant Print Applicant Name 3 N- --1 .— l 'Lk Date