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HomeMy WebLinkAboutCLE201400060 Legacy Document 2014-04-18,r y A. x K K 1( f'�i mFuP, Application for Zoning Clearance`: J:1 �' r i' CLE # lb 14 - � 4` � :.„:s` OFFICE USE ONL �g �i i^ 5 , 4-1 PLEASE REVIEW ALL 3 SHEETS Check# Date: Receipt # Staff: YY —r - PARCEL INFORMAT ;, ON,, i Tax Map and Parcel: LD !- 1 _ _ Existing Zoningl)wfvjd lyvda Mod Parcel Owner:- rjLU �11� ' r d Parcel Address: ©fir � - City (',�na, {i0M;1kState V 71 Zipo���� (include suite or floor) PRIMARY CONTACT p ��, Who should we call/write concerning this project? L& 3k- Q- `tea wW� Address : �'� l�1 p lo'1 7l( T \ FII\n l CityC' ( © X01 (t State Zip"a 101 Office h: (_ ) 9016 -[ - I � Cell "# 12(o -7 Fax # E -mail 10 ba U m -gym bamq a cey� APPLICANT INFORMATION Check any that apply: Chan of ownership Change of use Change of name New business �'Lge r� Business Name/Type: 1 J bue 21 � � F`'n� C/P- &sn Ll -C Previous Business on this site L OuyY\� Cj M b Lt b 1 n o 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 prov,:de: Of iCQ, i "tryZ;t't�Yu1 to he :. 1.��P -lid -7 nYDtn e InhZ:Q a f c�C re .e.t= Pif%1Y5' *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 percussion to use the space indicated on this application. I also certify that the information provided is true and accurate to best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature L�c/i/Y"� 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. Notes: Building Official „, - c s Date l p� Zoning Official Date �� Other Official -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 � F 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 / Wil 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 Circle the one that applies Is parcel on private well or ublic water) If private well, provide Healt 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 o pp is sewer. Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. 2 Permit # Y/N Will there be any new construction or renovations? If so, obtain the prpper Permit. Permit # I L- 7,nninu to emmnlete the fnllnwing: Reviewer to complete the following: Square footage of Use: 0/ N Permitted as: A %J , LA o 1 , C '� Under Section: < i A , 2 , I Supplementary regulations section: Parking formula: D Required spaces: Y/ Items to be verified in the field: Inspector: Notes: Date: Viola ,ions: Y /N) If so, ist: Proffers: 6) / N If so, List: 9)-0 Vari ce: Y/O If so, List: SP's- Y/O If so, List: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 10 J• n e ! 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, was provided to [County application name and number] [name(s) of the record owners of the parcel] and Parcel Number manner identified below: the owner of record of Tax Map by delivering a copy of the application in the Hand delivering a copy of the application to 1) ow ngc [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the reci pient 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 reci pient of the record and the reci pient's title or office for that entity] on Date to the following address: [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]. �0� i1� Signature of Applicant L—oY-ec. 7 . (3a u Yn Print Applicant Name 41 1 1 1 �)--0 l + Date