HomeMy WebLinkAboutCLE201400047 Legacy Document 2014-03-31of .vr
Application for Zoning Clearance 1'`
CLE # Zv (`{ - L/ -7 , r
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 3777 `1 3 Date: Z5
R Staff:
PARCEL INFORMATION f f
Tax Map and Parcel: Existing Zoning L,[o`i�QUs L
Parcel Owner: Cv C 4t c Anse /
Parcel Address: 1511 i�/yrtJ `�wOc -o City �� Cl iill� State 'J • Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? TO bo -
Address : 1325i' (� i %u' ��1� City > ... State Zip 22' D
Office Phone: (�c7 62S' 195v Cell # �l�S ° -79ly Fax #0q &Z/
E -mail Din Gfocwikt
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use nn Change of name New business
Business Name /Type: - -
Previous Business on this site c OC n) Co-
Describe
the proposed business including use, number of employees, number of shifts, available arking spaces, number of
vehicles, and any additional information that you can provide: _20u, �`'
*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 Iodation, a new Zoning
Clearance will
I hereby ertify th4 n or have the owner's permis ion to use the space indicated on this application. I also certify that the information provided
is true d accurat t e s o my owe ge. ave read the conditions of approval, and I understand them, and that I will abide by them.
Signature`s' /\ Printed
AA,�WVAL INFORMATION
] 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
Zoning Official
Other Official
Date��
Date / /2 "y
C . 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
a
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,
Z.vnJ�roq, G�c -ARAN
[County application name and number]
was provided to (-, it Co . the owner of record of Tax Map
[nam (s) of the record o ners of the parcel]
and Parcel Number (5 7� F (- oo- oc-oolo 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
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 of the record and the recipient's title or
office for that entity]
on 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].
A
rzn set i Ro-gg —F
Print Applicant Name
Date
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/N
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 public water?
If private well, provide Heat epartment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
Y /No
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/0
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
_ r_n
Reviewer to complete the following:
Square footage of Use: p4lA; �l 4V G%
P as: � �,ni'i`rAi�j.�_�,�n ��`l6t c
Under Section: '2--? • 2 -
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Gonln TO com
Violations:
/ N
If so, List:
fete Me iuiivrvui
Pro rs:
Y /l
If so, ist:
Variance:
OIN
If so, List:
-79
— <V
SP's:
Y/N
If so, ist:
Clearances:
SDP's
onU- �5
Revised 7/1/2011 Page 3 of 3
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