HomeMy WebLinkAboutCLE201400043 Legacy Document 2014-04-07Application for Zonina Clearance
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CLE # 2.O I —
fVM; Nth
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 77-47 Existing Zoning PD S C
Parcel Owner: Hillcrest LLC
Parcel Address: 32 Mill Creek Drive City Charlottesvill& ate . VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address. W.A YI'Iz thclu _ . ,_ City Lu State VA Zip 'N'502—
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Office Phone: 4LN ZSZ-Z-093 Cell # 0") (-71"11 7.7, Fax E -mail r-S yc.09 @ 5v 4 , c-1—
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use_-, Change of name X New business
Business Name /Type: Bloop Frozen Yogurt
Previous Business on this site Universal Video__
Describe the proposed business including use number of employees, number ofshlfts ava parking p � tuber of
tacesu
�,.,, ' llable
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vehicles, and any additional information that you can provide: Sa-hp: .c,
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*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anowZoriing
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 best of my knoNvledge; I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �l Printed
APPROVAL 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.
'Notesc.
Building Official _ Date
Zoning Official i "" _ Date-
.
Other Offici ,tnc�µ un./S . Date
a4 r t)
County oI Alumarie meparimem of Vommuaity tUevrfuPL1LVUL-
401 McIntire Road. Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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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 /
Will re 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
Reviewer to complete the following:
Square footage of Use:
Permitted as: i w.
Under Section: 2.
Supplementary regulations section:
Circle the one that applies
Is parcel on private well ublic w 7
Parking formula :�S ��
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE
-.
.o
Circle the one that applies.
Items be verified in the field:
Is parcel on septic or rx. lic solver
:9/ N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector.: Date:
Oil'l
Notes:
here be any new construction or renovations?
If so, obtain the proper Permit.
Permit # -)=I) I-y�G /� U
`
Zon
If so,Zist:
3y /N
If so, List:
9� -zU -
Clearances;
Y N
If so, List:
IN
�
f so, List:
SDP's
. /_ I/ .
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) ifthe application is not the
owner.
I certify that notice of the application, 7onWg Clearance Permit
[County application name and number]
was provided to Hillcrest LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel] .
and Parcel Number 77 -47
manner identified below:
,by delivering a copy of the application in the
X Hand delivering a copy of the application to Denise E. LaCour, Manager of Hillcrest LLC
[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 March 6, 2014
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].
Sigaature.of - ,piicarit
Print Applicant Name
�. �x .3-13• -ly
"' Date