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HomeMy WebLinkAboutCLE201400088 Legacy Document 2014-05-22Application for Zoninff Clearance CLE # OFFICE SE O Y r- I -)4- PLEASE REVIEW ALL 3 SHEETS Check # - �� Date: iJ `i" Receipt # Staff: PARCEL INFORMATI�),N n�' Tax Map and Parcel: '��J�l�°" ®� Vj�!`C�xisting Zoning Parcel Owner: 'A Q i7�e� LC_ Parcel Address: _<69(" ' Vii 5 -r. . City Cf)zii6A' _ State ' t/1 Zip (include suite or floor) PRIMARY CONTACT__ > ,l Who should we call /write concerning this project? � \"C-�i s, /y/� �i ` «e-1 i Address : "RCL� �'� J N�° �e City C'Yl�z State V i� Zip ` 3 Office Phone: (5 � 9go 6,v,—Q2 Cell # %() C,a ;3 -52. Fax # — I E -mail APPLICANT INFORMATION Check any that apply: Change of ownersh of use Change of name _Y'New business Business Name /Type: -' Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, nnumber,of vehicles, any addition 1 information th o, can provide: M_ J` g *This Clearance willoAly be valid on the parcel for which it is app ved. If you chatige, 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 knowledge. I have read the conditions of approval, and I understand theme, and that I will abide by ahem. Signature yv _ Printed APPROVAL INFORMATION Denied Approved as proposed [ ] Approved with conditions [ ] [ ] 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 I Zoninng Official Other Official Date ;J (4 ( t Date 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 I , Intake to complete the following: Y / 1�I LI Is use in , HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / �I 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 r public �ment If private well, provide Hea form. Zoning review cannot begin until we receive approval from Health Dept. FAX DATE . Circle the one that a�ji.es Is parcel on septic or public s "ewer Y/N Will you be putting up a new sign of any kind? Sign permit. Permit # Reviewer to complete the following: Square footage of Use: Permitted as: LAS Under Section: —TL) Supplementary regulations section: Parking formula: ZDa n/ Required spaces; Y / l✓ Items to be verified in the field: If so, obtain proper Inspector : Date: Notes: Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # z,oning LU CUM 1CUe Me lvllvvl 11 Violations: Y / N If so, List: Proffers: Y/ If so, ist: Variance: tV/ N If so, List: v� �� ��/ SP's: Y / If so, st: Li �J� a 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, [County application name and number] was provided to �0.� ` kA (�o�l/ I ©c���Vche owner of record of Tax Map [name(s) of tholrecord 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 [Name of the recor r 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] onv i'6 4Da e IZ� 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 to the following address: Date [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]. iznatu of App Print Applicant ame Date V+ S--(o I-