HomeMy WebLinkAboutCLE201400058 Legacy Document 2014-04-24Application for Zoning Clearance
CLE # 2-614 - 58 t
OFFICE __
PLEASE REVIEW ALL 3 SHEETS Check # _ j Date.
Receipt # t71� Staff•
PARCEL INFORMATION .-7 �j
Tax Map and Parcell: / a — % 5~ G ^ Existing Zoning
Parcel - Owner: LJLPCtN /%�L i�iU� jZLC57
Parcel Address: City (2. �a Sv% l� State V. �
Zip 2%I1
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(include-suite-or iroor) _ . .
PRIMARY CONTACT
Who should we call/write concerning this project? `�����, ,. I�� • I, f ��
Address • IQIS R'bJj-J br, v1 l State Yom%%
���(' / Zip 0% /l
Office Phone: ( `9• -90/ Cell # 906 ° ,2�88 Fax # �S� E -mail S�oeoy irf, a 1cj&m , ax, ea wK_
APPLICANT' INFORMATION
Check any that apply: 11 Change of ownership Change of use Change of name v-" New business
Business Name /Type: MT u-M �Ee,�n; (vw,na. ,.�,�/e—
Previous Business on this site /A;1 _ x6t
Describe the proposed business including use, number of emplo ees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
*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
CIearance will be required.
I hereby cAralcttoo7e or have the owner's permi ssion to use the space indicated on this application. I also certify that the information provided
is true and best of my knowledgee.. Ihave read the conditions of approval, and I understand them, and that I will abide by them.
Signature J Printed �"_ �e__ o 14
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 � Date
Zoning Official % Date 0 %��
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
Intake to complete the following:
Y /@
Is use in LI, HI or PD1P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /NQ
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_
ircie sue one tear applies
Ts parcel on private well or 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 ore sewer.
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comnlPtP the fnllnw-ina.
Reviewer to complete the following:
Square footage of Use: S `�
0/ N
Permitted as: v G{
Under Section:
Supplementary regulations section:
Parking formula:, / ___.�1
o a r��/1
Required spaces:
Y/
Ite to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/10
If so, List:
Proffers:
Y /c1
If so, List:
Vari , ce:
Y /(1
If so, List:
SP's:'
Y/
�
If so; List:
Clearances:
SDP's
Revised 7 /1/2011 Page 3 of
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EXHIBIT A
FLOOR PLAN
198 Spotnap Road, Suite C -3
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CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE ]LANDOWNER
This form must accompany zoning appiications (Home Occupation, Zoning Clearance, it
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
Miler.
I certify that notice of the application,
2or,--I-w G- LLeA0 -A Q�
[County application name and number]
was provided to C fiL'fLt `zs W ' i{c n-z the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to S -T-Lc
[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 d 1 *0 k
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
Date
to the following address:
[address; written notice mailed to the owner at the last known address of the owner as snown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
ignature of Applicant
Print Applicant Name
14
Date