HomeMy WebLinkAboutCLE201400087 Legacy Document 2014-06-05Application for Zonin Clearance''r��,
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY 0011'L ) )1
Check # Date: 5 /
Receipt # 5 Staff:
PARCEL INFORMATION // l
,M —)2.— 1 C Existing Zoning Plon4frj ay
Map Parcel: (P) � '
Tax and /
Parcel Owner: ��/� 7t't WO U , L l,/,
Parcel Address: L)60 v/eAy)vy h Pkce, City ���ollfll7��i�� State Zip D ?0
(include suit or floor)
PRIMARY CONTACT
LY-1 \Alc d
Who should we call /write concerning this project? gj
Address: /6)2) �� c�`� �S�S e'� W City `� o��o State Mc Zip
Office Phone: (_'�- Cell # `'" 1 e ��� Fax # " E -mail
Su e rJ l't,kj arcie o >na, a Caws
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change off New business
_name
/ /
Lif 1� /�1 1C. I
Business Name /Type: rr i G &r9)C ('C. all"k
Previous Business on this site U,6)eV) VUj#) — �iC%Gr 1 �P 51,C
Describe the proposed business including use, number of employees, number of shifts, available parking space , n tuber of
vehicles, and ny additional information that you can provide: j'Gc„y* -CA.") 5�r�. =2_
h, l� <s
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*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 the owner's permission tp.,Ase the space indicated on this application. I also certify that the information provided
is true and accurate to est of my knowledge. I hpe e the conditions of approval, and I understand them, and that I will abide by them.
Printed ve- r -
Signature r9`^ 94C:
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
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/
Is use LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/1
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 wellp°• rpu ,1i.e-w.tter?
If private well, provide Hv-alt went form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public-
Y/N
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 construction or renovations?
If so, obtain the proper Permit.
Permit #
7.nnina to emmnlPtP the fnllnwina-
Reviewer to complete the following:
Square footage of Use: / 6/ 2 J�
Y /N /
mitted as: %d b --
Under Section: 25. 'L , /
Supplementary regulations section:
Parking formula: '-IlDI°ii'� c �
Required spaces: 6
Y/;�)
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
O/N
If so, List: 1 A
Proffers:
Y/�
If so, ist:
Variance:
JIN
If so, List: Q
SP's:
6) /N
If so, List:
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4n -3f
gy-4Z � —
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, L(y) Two^ 5 °�` h fl. re
[County application name and number]
was provided to � , Wpefs WO W , LLL_ the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number Yo „ ► by delivering a copy of the application in the
manner identified below: C
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
LC
Z"'Mailing a copy of the application to S��'�P �ic,l1�L �Z'�C�iif F r' S
[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] i1
on 412 / � Ll to the following address:
Date
M10 20
[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 App icant
C
Print Applicant Name
Date
I
Cot,[ -
EXHIBIT A
SITE PLAN
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