HomeMy WebLinkAboutCLE201400076 Legacy Document 2014-06-03Application for Zoning Clearance
oFFrat, u
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff.- Tim
PARCEL INFO ON
Tax Map and Parcel: w - CQ - a 1 Q0Q Existing Zoning
Parcel Owner•
Parcel Address: 3 y � r.� [ -c City C�,'.r. I L, State t. k, zip—
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? U.i .S
Address : qu Lr ca'.'ldlv4 'k Y2-.( Clh'__ 'IL State__ zip
Office Phone: CL3 � 11.3 1,) I Cell # t.o- S Z6 Fsx # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name4'ype: —CeAf.112 Aln
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parldug 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 eertifythat 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 a7r best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by therm.
Signature Printed U ex-01 {�-
APPROVAL INFORMATION
] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacldlow 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 ZZ __1t,_C_� —
Zoning Of dal Date 0v y
Other Official Date z L
.. _
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:
YIN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet,
YIN
Will there be food preparation?
If so, give applicant a Health Deparhent 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 ublic w r?
If private well, provide Heal epartment form,
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic or ublic-
YIN
Will you be putting up a new sign of any kind? If so, obtain.proper
Sign permit.
Permit #
Y/N
Will there be any new construcdon or renovations?
If so, obtain the proper Permit.
Permit #
Zonin to complete the following:
Reviewer to complete the following:
Square footage of Use: o
d / N.
Permitted as:
Under Section;
Supplementary regulations section:
Parking formula:
Required spaces:�
YI
Items to bg verified In the field:
Inspector : Date:
Notes:
Violations:
Yl
If so, Dt
Pro rs:
YI
If sv, ist:
Vari
YI 1ce:
If so, t:
SP's:
IN
so, List,
3-�
Clearances:
SDP's
r
Revised 7/1/2013 Page 3 of 3
e 10
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
Thos form must accompany zoning appldaatdons (Horne Occupation, Zoning Clearance, Zoning
Administrator Determinations orAppeals, Sign Permits, BuildingPermits) dithe applicadion is not the
owner.
I certify that notice of the application,
[County4lication name and number]
was provided to �`�1z _ the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and parcel Number $(o ao •� • O i
� - - _ —by delivering a copy of the application in the
manner identified below:
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 19,�b 1 1-.
[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 S-,15- 1 to the following address:
Date
CA, Zn L 4 CJ� Z7st J
[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
L hk-
Print Applicant Name
E;- 5"- 'A
Date
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