HomeMy WebLinkAboutCLE201400098 Legacy Document 2014-06-04Application f ®r Zoning Cleaarance
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CLE # 2 o 1 y — ''1 (�
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Cheelc # 2q<- Date: 5 Z
C_ I— Receipt# eiS 7Gi0 Staff;
PARCEL INFORMATION C �
Map Parcel: -iJ
Tax and Existing Zoning ...
Parcel Owner: w V U
Parcel Address:_4ub 'J bg- ac-LL, j a iqr- City MV LUC State _VA Zip u1
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
Address : - 1 UD W b(`R LL P RI V. City O V I L State A Zip V_q I I
Office Phone: Zyt'� " bZ3� Cell # Fax #.2M " 42115- E -mail LSO 7,1)0 Vl Vrl Al G , eQ N
APPLICANT INFORMATION
Check any that apply; Change of ownership Change of use Change of name New business
Business Name /Type: K1 IACP e' yl�,� -Q /k C�, \J C
Previous Business on this site y V D yf dA � V1 kAl 69 V1S
Describe the proposed business including use, number of employees, number of shifts, available parking s aces umaber of
vehicles, nd any addit' naI information that you can rovide: O'D ✓ 4 V, Q
I( &11m q va e. L
*This Clearance will only be valid on the p rcel 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 applicatiop. I also certify that the information provided
is true and accurate to the best of edge. I have read the conditions of approval, andd I understand them, and that I,w,iillll abide by them.
VnMio
Signature - Printed `'' `y l� IL� I�► I y 1 y I" (y
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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
Zoning Official Date i & 117_b }
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
I 5 '
Revised 7/1/2011 Page 2 of 3
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Intake to complete the following:
Y/(Nj
Is use n 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 or ublic water
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one applies
Is parcel on eptic r public sewer?
Y�N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y /l&
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comoIete the following:
Reviewer to complete the following:
Square footage of Use: %U U x 1Sd
d / N.
Permitted as:
Under Section: -33-1
Supplementary regulations section:
.4 Pa,
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
YA
If so
roffers:
6/N
If so, List:
Variance:
Y /
If go, ist:
SP's:
Y /0
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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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, 2,0 R I C `�`" ' a
Na . [Cou t application name and number]
was provided to N u f;m Ja ,'V1I the owner of record of Tax Map
[name(s) of the orj'dd owners of the parcel]
and Parcel Number -1 � 1 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 .
v 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 lv ` Z � 1 to the following address:
Date
�-o -�OA So a-A-� kJ �Ao�e D,�V))�
[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].
ignature of Applicant tl
UA-1i Rf- tit M
Print Applicant Name
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Dat
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