HomeMy WebLinkAboutCLE201400092 Legacy Document 2014-05-28Application for Zoning Clearance6;z'�'`
CLE #
OFFICE SE . NLY i
ib
PLEASE REVIEW ALL 3 SHEETS
Check # ' Date: - I
Staff:
Receipt #
PARCEL INFORMA
Tax Map and Parcel: -_ Existin g Zonin g
Parcel Owner:
J --�,�
Parcel Address: (jJ -��n City �1'P��+► 91 Cz., --(,State �" a , Zi ��
(include suite o floor)
PRIMARY CONTACT
Who should we call /write concerning this p 1 L�.�$
El
'�roject?
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Address : LL' � yr �4� 4_1110.0. City U_0J\1i�t.1 State Zip
Office Phone: ( t� � Jd Cell # J-- �� Fax #� —,Jtjo E
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of uuse Change of name —Y—New business
Business Name /Type: Rtvve,- A° �� K�� � %� 1 1�, PLC
Previous Business on this site
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: c
*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
best knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
is true and accurate to the of my
Signature —Printed fL6' s -r1-)r- L. % "�r-A(�'-t T"`
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.
Therefore, it is not a determination of compliance with the existing
[ ] No physical site inspection has been done for this clearance.
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official �— Date l3 l ciif
Official Date
Zoning
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 ' 0
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
Enginneeerr's Report (CER) packet.
Y
Will t ere 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 h1__jc_ateO w?
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 septi r nblic sewer?
Y/ )
Will y oou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /(N J
Wili ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
1 th f 11 '
Reviewer to complete the following:
Square footage of Use: 7
N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula: /
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Zoning to com r, M e o owm ,
Violations:
Y/ ?9j
If so- ist:
Proff rs:
Y /
If so, List:
Variance:
Y /(�
If , 1st:
SP'ss�-�•
Y /lJ
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of
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 the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in,the
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
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].
Signature of Applicant
Print Applicant Name
Date