HomeMy WebLinkAboutCLE201400081 Legacy Document 2014-05-12Application for Zonin Clearance�61��
CLE # c4 — S
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # 7 1'6'1 Date: / 7
Receipt # S'S'T' Staff: _
PARCEL INFORMATIO - jC
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Tax Map and Parcel: _l Existing Zoning [
Parcel Owner: ' V vs'
Parcel Address: 1 O CityC�GU'(�1 Vi11� State Zip) l t 1
(inclu suite or oor)
PRIMARY CONTACT �1
Who should we call /write concerning this project?
Address :F0 1�ox 5 ka t Cityc 14�V e State v Zip
Office Phone:
Cell # Wei -SJ \—M 3 Fax #�3 `%M l E -mail M���CS (Q�7 G6�ICOtn�
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: UU�S Vey CCjY��
Previous Business on this site
Describe the proposed business including use, number of employes, nu b fshi ts, a ailabl parking s aces, umber f
vehicle , and any additional i ormatio th t y u can provid : v1 5G C7 5 S
ckG l WO 1 C S 2 ve
e s
*This Clearance will only be valid on the arc 1 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 ao to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
�E'�1V115 1��IV1�Cl Vl
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 �Ly
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
Intake to complete the following:
Y /O1
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y / t tf!
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 or u lic water?
If private well, provide Health 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 or u lic sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Ygo
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # _
f 11
Reviewer to complete the following:
Square footage of Use: G`3 -
)/N /
ermitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces: ..Z�.,
Y/
Items to be verified in the field:
Inspector
Notes:
Date:
Zoning to complete the o owm ,
Violations:
If so, List:
Proffers:
Y/
If so List:
Vari nce:
Y (N,
If sist:
SP's:
Y /
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of
Y, P
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 ap Iicatji,
\j� TOUS [County application name and number]
C U kn� was prov ided to � veT-- the owner of record of Tax Map
[name(s) of the recoers of t arcel]
and Parcel Number _ -�-)q C by delivering a copy of the application in the
manner identified below:
AL Hand delivering a copy of the application to
[Name of the record owner i h record o n r 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 I
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 shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
V�1
Si f Applic ant
V��5 `�_
,VY A
Print Applicant Name
Date
EX BIT A: Floor Plan & Improvveme
MECHEMS RIVER SECURITY CONCEPTS, INC.
X98 Spotnap Road, Suite B4
Approximately 597 SF*
24 -�• 597 SO. FT. -
.. � 4 -3j t �
x
10'
5' -2'
389.5625 SQ. FT.
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8'7"4*
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* The measurements on this, f �Ioor plan are believed to be accurate but are not guaranteed.
Lessor will paint the Premises throughout; Lessee will select color from samples provided by Lessor.
EX BIT A: Floor Plan & Improveme
MECHEMS RIVER SECURITY CONCEPTS, INC.
i98 Spotnap Road, Suite B4
Approximately 597 SF*
The measurements on this floor plan are believed to be accurate but are not guaranteed.
Lessor will paint the Premises throughout; Lessee will select color from samples provided by Lessor.
11,11
- , �� �._
J
'
12 21
Ilk
24
-5"
597 5Q. FT.
{� fl
389.5625 SQ. F-F.
5112°
WIN/.
f
10'
-10'
a=te
4
o
�
i
The measurements on this floor plan are believed to be accurate but are not guaranteed.
Lessor will paint the Premises throughout; Lessee will select color from samples provided by Lessor.