HomeMy WebLinkAboutCLE201400053 Legacy Document 2014-04-09RECEIVED 03/19/2014 15:43 4349797394 MONTEBELL PRP & INV
COMMUNITY DEVELOPMENTI Fax 4349724128 Mar 19 2014 0 :Oipm P002/004
Application for Zoning Clearance
CLEN
i
OFFICE
PLEASE REVIEW ALL 3 SHEETS Check # Date: `
' 1 .Receipt # Staff,
PARCEL INMRMA nI ON -
ax Map and Parcel: Existing
Parcel Owner: /Z' r . -I-e evr 2 %r—. n,, re t L e
I
i Parcel Address: 1_y a n k M= v. p� City � 2 96 1
I ty State tip
include suite- r floor)
.•
,AMY COWACT I
Who should we Cali /write concerniwg this project? " D 9
Q M.2
f#ddresS a d d : xi L �- l < -/ `; yv City h r L e %r'y State X,/:,r Zip f
I � I
t?ce Phone: 1j. Fax # 79 -13 FE -mail
APPLICANT ENKFOR.M'A 1011V
Check any that apply: . Change of ownership Change of use Change of name fiew business
Business Name/T1
pe: 1�7a y-'�1� L L e [
Previous Business or this
s
Describe the proposed business�tcluding use, number of employees, number of shifts, available parking spaces,
vel<ti:les, and any additional 1formation that you can provide; ,-
IF
"Mis C7earanee will only be valid on the parcel for wl*b it is approved. If you change, intensify or move the Ilse to a new loeatfor
'
Cla-aranct wifl be required.
i
I hereby certify that I out or have the owner's pernsission to use the space indicated on this application. I also certify that t,3e infosn
is t: ue and'aceurate to the best ofmy knowledge. I have rcad the conditions of approval, and I understand tbcp7, and that I will abide
gigtlature .. &�, Printedd
AP�`it�0i%AI- rl�O CPVIATIOIv
Approved as proposed [ j Approved with conditions [ j Denied
J Sackflow prevention device and/or current test data Deeded ;for this site. Contact ACSA; 977 -451 I: x 117.
C ; No physical site inspectior has been done for this clearance. There fore, it is not a determinatiox of compiialoe wit;
site plan.
( j This site cornplics with the site plan as of this date.
Notes, `
Building Official
Date
Zoning Official
Date
Other Official
Date
County of Albemarle Department of Community Devalc
4011*Wntire Road Charlottesville, VA 27,902 Voice: (434) Z96- 5832,'
m
9
of
anew
on provided
them.
the existing
,went
5x:(434) 972 -4126
Revised 7,1/20 1 Page 2 of 5
RECEIVED 03/1912014 15:43 4349797394 MONTEBELLO RP & INV
COMMUNITY DEVELOPMENTI Fax 4349724126 Mar 19 2014 0441p P004/004
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE ,LA,NDOWNI
This form gust accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
AdrninWrator Determinations or Appeals, ,sign . Permits, Building Perm&) if the application is not
owner.
I certify that notice of the application,
on name and number]
was provided to QA6 Ir K W a,.t p iK L L. a the owner of record of Tax
[name(s) of the record owners of the parcel]
and Parmei Number :',�: by delivering a copy of the application in ti:
manner identified below: o<
Hand delivering a copy of the application to - & 6 - 9- b ,
(Name of the record owner if the record own 6r is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient'
title or cffice for that entity]
on
Date
Ylaiiing a copy of the application to
rl it A
(Name of the ;record owner if the redrord owner is a per;
if the owner of record is an entity, identify the recipient of the record and the recipient's title
oif ce for that entity]
on qtt I t Ll to the following address:
Date
[address; written notice mailed to the owner at the last known address of the owner as shown
the current real estate tax assessment books or current real estate tax assessment records satis
this requirement].
v
Signature of A,pplicaut
Print Applicant Name
Date
RECEIVED 03/19/2014 15:43 4349797394 MONTEBELLO RP & INV
COMMUNITY DEVELOPMENTI Fax 4349724126 Mar 19 2014 04;0 pm P003/004
j Intake to complete the following:
Reviewer to complete the following:
Y / N
Square footage of Use:
Is use ir% Ll, HI or P173Y zoning? If so, give applicant a Ccrtifiied
mngineer`s Report (CER) packet.
i2a,u�fl�r.�faniesS S'LYV�
+'+
. ermittcd as:
lY /N
Will there be food preparation? Gila
J
Under Section: � � • 2 /
If so, give applicant a Healti'i Department form.
Zoning review can not begirt until we receive approval from Health
Supplementary regulations section;
Dept. FAX DATE
SDi"s
Parking fortnula:
Circle the one that applies
is parcel on private Weu or?,- p' ic. ater7
If private weal, provide Neal ' Gap , nt i'orrn.
Zoning review can not begin until we receive approval from Health
Required spaces:
1 Dept. ;FAX DATE
� /
1
:Circle the one that applies
Items be verified in the field:
Is parcel on septic 9r4iLf61>:C,s r? }
:Y /N
i Wit; yon be putting up anew sign of any kind? If so: obtain propel"
—
tiign permit. oYo
Permit
Inspector, Rate:
/ N
Notes:
"Will Encre be any new construction or renovations?
if so: obtain the proper Permit,
I;erm t 0 _
i
Z oninL7 to comoiete the following:
viol owns,
/
if so, List:
Proffers:
Y/(29
If so, List:
i
+
r ,
1 1 ce:
V /
if So-'List:
,SP's:
y %
if so, List:
Clearances:
SDi"s
V
Revised 711/70111 I age 3 of