HomeMy WebLinkAboutCLE201400096 Legacy Document 2014-06-02Applicati ®n f ®r Zoning Clearancelzy
CLE # oi014 " Ct(3
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # H Date:
Receipt # C 5 Staff: f')T_
PARCEL INFORMATION y
Tax Map and Parcel: ?(ebb ~�'�^ �G� Existing Zoning N(�,
v1► a LavxA �V ga-,eA HU br Lew-
Parcel Owner: / l rn i
Parcel Address: city State VA Zip 2291
Onclud suite or floor)
PRIMARY CONTACT
'1 ITV1 C- •}airYl �1ga✓1
Who should we call /write concerning this project? lC�
S i��rta�t ��� City aar-164C %Atle- State 1sT Zip Z2Q03
Address.
Office Phone: Cell # 327-2-1loS E -mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name Ne w business,
0)(l t ` �SSogdles
Business Name /Type: t LCS i o) S 1� U"S ®
�r � r-- � 1 AL V40k pPa
Previous Business on this site -�
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
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vehicles, and any additional information that you can provide: ri
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a Pr a
a A a�n r o
*This Clearance will only be valid on the partdl for hich it is approved. If you change, intensify or move the se to a new location, a new Zo ing
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 bes of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Printed —z i 'r c vL
Signature I V1
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 --Z- r 1.4
Zoning Official Date
Other Official Date
County of Albemarle imparEment of t-uuuuu►ulay Lcvc.vFlllvA..
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y / ��
Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Will re 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 CDe ater?
If private well, provide He ent m.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap i
Is parcel on septic o public sewer?
Y /
WiI14 be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Pgr- 't #
Y N
Wil ther be any new construction or renovations?
If so, tain the proper Permit.
Permit #
7.nnina fn ommnlPtP the fnllnwinu!
Reviewer to complete the following:
Square footage of Use: )5i(
YIN
Permitted as: ETC- ( e
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
YIN
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
If so, List:
Proffer
Y
If so, List:
Var, ance:
Y/
If so, List:
SP's:
Y/
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, ( -P�261y 94
[County application name and number]
was provided to
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
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_ on it
�✓ 1 �rl 1 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].
Sigtiature of Xpplicant
Prin� cant Name
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Date
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