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HomeMy WebLinkAboutCLE201400065 Legacy Document 2014-04-21Application for Zoning Clearance CLE# Z,oly - 1 � �AGR3lPt OFFICE USE ONLY Check # 754S70 Date: il 1 7 1 PLEASE REVIEW ALL 3 SHEETS Receipt # q l' 2 Z,C7 Staff: PARCEL INFORMATION 3- /� .2 3 2— Y 2 i Tax Map and Parcel: (,(i , r Existing Zoning Parcel Owner:_ .Muir / C /4p L L Parcel Address: A,C� s% City Ile- State (1,,!;P Zip 2.2 % 6 ) (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? r /� Address: ��sa L /,4� /"� J' I ,� tf - City nState ( Zip Ow/b% Office Phone: �/ 7 / � G!✓ell # Fax # �% /S -.? /?-(--//X-mail �wct i cll re APPLICANT INFORMATION Check any that apply: Change of ownerrrship. Change of use Change of name New business Business Name /Type: �(/ T�� y 4�, A� u (!� .�-- Previous Business on this site /Up 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: �� °�r� C,@e , c r� n��':r� -Ara i nczu cz h o r h4j,U 6 412 . el�; *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 best of my kn ledge. I have read the conditions of approval, and I /understand them, and that I will abide by them. Signature C�'J' L c`7 Printed F"� �4cy Le f� 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 T Date `( 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 7/1/201.1 Page 2 of 3 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 /U 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 o ublic water? If private well, provide 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 septic o public sewer? (9 /N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # 02,7 y S 9-- vc, 0,, / — o© 3 '73--S Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit# .2,01.7-- IS-afAC- Zoning to complete the following: Reviewer to complete the following: Square footage of Use: /'Y-,6)00 i)lN �g Permitted as: ✓ "l �i► Under Section: 4-4 • %'174 Le, G, C4, Supplementary regulations section: Parking formula: y5 /vet d Required spaces: -57 Y/N Items to be verified in the field: Inspector: Notes: Date: Violations: Y/N If so, List: Proffers: (Y) ) /N so, List: ZM4 Zz, 1 9 N 11-- 2-U / 0 riance: /N If so, List: n SP's: Y /NO If so, List: Clearances: SDP's 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) if the application is not the owner. I certify that notice of the application, (0("4 Zg-&Z 2,110 [County application name and number] was provided to e /��� r l aif e �74,4 P 1-1-6 the owner of record of Tax Map [name(s) of the record owners of the parcel] J k3 a.y, � s' and Parcel Number 60, 10,u /,- /S 3-1 > 4 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 vJ Mailing a copy of the application to �% /�r'rh �r 1 fir /�"`1 L,L.e [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 -3 /ter �Ly to the following address Date 'n /)emaw /G. TlQc,- e *AI*,, 'c/ � /7,�ba UJr,sconl':rU Befti al'da ,e✓1 n I ) Ply [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]. r i gnaturdof Applicant 141,q -j2 W &�U U ct� Print Applica t Name 3/,0 �a-o , -v Date #