HomeMy WebLinkAboutCLE201400100 Legacy Document 2014-06-06Application for Zoning Clearance
CITE #_ �b 14 - it)
PLEASE REVIEW ALL 3 SHEETS
OFFICE US 17m
Check# ," Date: to _4 - 1 4
Receipt # Staff-.
PARCEL INFORM%ION '
I kJ 4 -101 bm NY,(
Tax Map and Parcel: Existing Zoning
Parcel Owner:—
Parcel Address- 3510 Qewiso C4 _"%A;'K to( city c"4L ael ',State BID �V'*f
(include suite or floor)
PRIMARY CONTACT
Who. should we can/write concerning this project? Ale Lold
Address: Al at 9ile Agh— City --9:2� elle —:state UA Zip 2"7 .2
I
C/
Office Phone: ( _) Cell #Y3q-S31-399't8ax'# ]E-mail A y4walzs�C • 60 I-In
APPLICANT INFORMATION
any'that apply: _ Change of Change, of use Change of name New business• ,
-Check
Business Name/Type-; A&wdeL (A ltsk4c A - _e�
V
Previous Business on this site /Upyle_
Describe the proposed business including use, number of employees, number of shifts, available parking s P aces, number, of
you can provide: 2h- S,04 -4
vehicles, and any dditi natinformation,th, 7
5-4-
*Tl.l:is Clearance will only be valid, on the parcel for which it is 4p.prQvqd.,lf y qu. chxpgejptqnsify oi- move thouse to a. new location ,:a:n.ew Zoning
Clearance,will be required.
T here by certify that .I own gr have the owner's pennission tq:use tbeispace indicated on this application.:] also certify that the infbrrnad`onprovidcd
is true. and accurate be Icnowledge. I have read the conditions of approval, and I hider them, and that I will abide by them.
/stand
Printed Ned �o
Signature vef
APPROVAL INFORMATION
>e Approved as proposed 1:4ppraved with conditions, Denied
Backflow prevention device and/or current test data .needed forthis site. Cbntact.ACSA, 977-4511, x117.
o 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. •
RuNing Official. Date Cam
zo ficia. l Date
"ing.Of Z_S h�
Other Official Date
County ofAlbemarle Department of Community Development
4101 McIntire Road Charlottesville, VA 22902 Voice: (434)296-5832 F= (434).:9724116
Rpvised,7/1/201 I Page 2 of 3
Intake to complete the following:
Y I
Is use -n(((n .L.I, .EII or PDI:P zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
v�
Wil sere be food preparation?
If so, give applicant a Health. Department form.
Zoning review can not begin until we receive approval, froaa Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o public water
If private well, provide Healt arunent forth.
Zoning review cannot beginn until wezeceive approval from Health.
.Dept, FAX DATE
Circle the one that applie
Is parcel on septic or nblic sewer
YIN
Will you be putting up a new sign. of any kind?. :if so obtain proper
Sign permit. , a
'Permit # � ,P,���
Y%N
Will there be any new construction & renovations?
If so, obtain the proper Permit.
Zonine to complete the following:
Re-viewer to complete the
Square footage of Use: � Yo&
& I N P(�.
Permitted as: l ji.Q. (A 5✓
Under Section; 2 '
Supplementary regulations section:
Parking ;formula: 4
Required. spaces:
Yl
Items to be verified in the field:
Inspector
Notes•.
;Date:
Violati6ns
Y.�
If so ist:
T'roff s:
Y l
If so,`` Ist:
V.arfa ce:
Y/
If so, i.st:
SP's�.�
Y(V
Ifso, List:
Clearances:
SDP's
Itevised 71112.01 I...Page 3 of 3
I]
O
Ii
x -►-
0
Z
r
O.
Z
K
O
O
r
N
C
LL
N
w
�::D
�0
zQ
-LL-
e
�mw
3 u tE
o
iE
W
J
J
w
W
rz
0
J
Q
U
W
r
r
rn
J
J
Q
O`
J
1
Z U I
'O�
Lid I—
U) Z
U) O
�E
i O O0
0 i
5� Yew
` Eaow
O
'MN33N1 dO 1N3M 153110! 3H1 0L 031033 nd 3911YH5 NOII00008d3H NO 35003ZINOHinvN0'NI3H3H 0311V130 AllV3I3133dS iVHl NVHL MID 350dNOd ANV 140303SR 301014 11NHS ONV 103LIH3NV 3H1 i0 ALH3d0Nd 3HL 3NV SONIMY4Q 353H1 N103NI- 0351101570 ONV 51!3314033H1
G
0
LL.
m
0
N
C�
N
r�
E
0
U
E
0
�IJ
V
J
_.
wmmw
'x.
L
LL
•O
N
N
T
CV
T
C)
N
N
C
C
O
00
A
On
U E
O
•E
E
P O
V V
A -0
O
� J
0
Q Z
,
v
W
2
+r f6
CO
Q. ..0
Y
=
N
O
O
N
O
�
CD
3
•,
a
a�
a)
E
�.
E
m
:a
U)
w
:
:3
O
07
p
m
c
O
E
CD
0
O
O
(�
Y
�
O
C
N
�L
O
+�
�
O
U
N
O
�
O
O
U
C
C
N
N
N
fS3
'Q
O
O
U
m
c
�
N
�+
a
W
O
U
�
a�
O
L
L
E
`6
O
O O
CL
y"•1 .�..i
Q.
M >,
U)
N
C/) L-
O
(n o
U L
° Y
C
L
U a
O
�p �
m
O
Y
21
T
O
(On
(D
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,
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
by delivering a copy of the application in the
[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 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].
r
K
CG
Date