HomeMy WebLinkAboutCLE201400078 Legacy Document 2014-06-03Application for Zoning Clearance
CLE # 2014 - 1E is
OFFICE USAN Y
PLEASE REVIEW ALL 3 SHEETS Check # Date: 5 GJ .14
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: _ � � O 3 - c3J - UJ Zc1J Existing Zoning C _ ��0, Etc =,, .j
Parcel Owner:_ 9J �� �.c� L, S L L
Parcel Address: _ _[ t>_ >- cam, ,,. a 9 t ru,, ! City r . k' V' L(-,t _ State U
(include suite or floor)
PRIMARY CONTACT II -
Who should we call/write concerning this project? i-
Address : [, (. C 44�,, 6U f ,2 City [% S i c d State A .._ zip Z2_•i
Office Phone: 8y, q17- z 11 t Cell # I c Q- Cl 2-1- Fax # E-mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change�o^f name New business
Business NamuType: L�l+�- �vu. -�'� n (�►r�� 4 1�: � tt i-�s -dA a1 a,,- K -
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:
*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
is true and accurate a best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by thew.
Signature PrintedC.e ^}'�
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Baciflow 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 4! [ t
Zoning Official Date 1/glZd %`�
Other Official Date
County of Albemarle Department of Community Development
441 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:
YIN
Is use in LI, EII or PDIP zoning? If so, glue applicant a Certified
Engineer's Report (CER) packet.
YIN
Will there be food preparation?
if so, give applicant a Health Dapfirnbent 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 public water?
If private well, provide Health Departmont 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 public sewer?
Reviewer to complete the following:
Square footage of Use:
Y /N -
Permitted ac
Under Section;
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to bq verified in the field:
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # Inspector:- Date:
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Pernilt.
Permit #
— saa
F2 r 11
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List: .
Variance;
YIN
If so, List:
SP'a:
Y/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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CERTMCATION THAT NOTICE OF THE
A 3PLICATION HAS BEEN PROVIDED TO THE LANDOWNER
Ilk form must accoslpany zoning applieadons (Bome Occupation, Zoning Maran", Zondreg
A neinislmtor,Dderm&46ns er,jipej*, B%%Pemits, Building Nrm ts). if the ppplicatforr. is not the
Owner
i certify thatnotice of the application,
(Cowty qphcatim name and m=beor)
waspmvidedto b pme, q h the owner of record of Tax Map
(namc(s) of the record owners aft m parcall
and Parcxl Numb' to D3 - t3 o - Uo Loa _by delivering a copy of the applicakioa k the
maanar idewi ied below:
Hand delivering a.cppy of the application to
[Nam .csfihere=d owmer if tlre record owner is a
person; ifihe owner of record is au entity, identify the recipient of the record and the recipient's
Me or oflte for that entity]
on
Date
X Maiiirrg a copy of the application to Rb _ --
[Name ofihe=ord awneriftba= rd ownwis apersan;
if the owner of record is an en ft, fdm*the re*ant of the record smd&c reoipicafs title or
office for that entity]
on ��yy��6 --g I Y _ _ _ to the Mining address:
Date
T),. ice' ,,N , i`L4 _ i),,L -Z7-9 -Z 1
(address; writtm notice mailed to the owner at the last known address of ffic-owner 'as -shown on
the cm=treal estate tax assessment books ox mti=t real wtate tax assessmentrecords satisft
this requirmucag.
C
Signature ofApplicaat
Print Applicant Name -
'=
Date
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