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HomeMy WebLinkAboutCLE201400104 Legacy Document 2014-06-09Application for Zonin Clearance_'�� CLE # 2ol q ^ tO � a71nx��s PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Cheek# l0 3 Date: 40/0/y Receipt # 9 S91 9 Staff: PARCEL INFORMATION f J / �, Tax Map and Parcel: :n �i A 6 � . At &(_,2L �(1 CL Existing Zoning A � 4 W41 Cin VL4 Parcel Owner: o /`0.5 (� C2,•�f4ak 1 Z Parcel Address: 2 / o r(,)Y Sr1 2,0/ City <f4AR �o / %J IJ /fkate 14 zipz2��� (include suite or floor) -PRIMARY -CONTACT — / Who should we call /write concerning this project? Sd 1`-' Address : 212Z bA-1,l rApe, �yo1 / City (f/wd v/I of /[- CState Zip Z? 7 Office Phone: Cell #223 5-17-225J Fax # E -mail c j ki -7r APPLICANT INFORMATION Check any that apply:, Change of ownership Change of use Change of name New business / n Business Name /Type: /7/�I%� � S f y,J3 �� �°f'e✓� - �e.t t-t'`y _et 10� Previous Business on this site et �[� � 4 ! d A_J Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of ve /h* les and any additional i .or a io thhat you can provide: / /25�y�r .` S �� /F3�;' 2S S P cC �-S -e A S *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 st of y knowl ge. I have read the conditions of approval, and II understand them, and that I will abide by them. Signature Printed 0 ! ! (A"� l4 • 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 -t ``% /G� Zoning Official Date ©,,9 l� 7 Other Official Date County of Albemarle Department of Uommumty iueveiopment 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 in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Will 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 well o public water Ifprivate_well, provide Heal_ ent form. Zoning review can not begin until we receive apl Dept. FAX DATE Circle the one that appli Is parcel on septic public sewer. Y /0 Will you be putting up a new sign of any kind? If so, obtain proper Reviewer to complete the following: Square footage of Use:�� 7/N / JJ Permitted as: / Moc +y �1 ✓(J Under Section: Supplementary regulations section: Parking formula: �' /�vo l,�Yd ✓3 T �F.r��l ul� Required spaces: Y/ Items to be verified in the field: Sign permit. o i r � C�e �-I Inspector: Permit # � k t 5151�rj ,5 ,� o I eAv Y I(N) Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7nnina to emmplete the following: Notes: Date: Viol ns: Y / If so, List: Proff s: Y/ If so, ist: Variance: <9 /N If so, List: SP's: �% /N If so, List: C) — 9!! S7 -° Z 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, was provided to and Parcel Number manner identified below: [County application name and number] the owner of record of Tax Map arcel]- - -- - by delivering a copy of the application in the Hand delivering a copy of the application to 10ee-)�05 ' , Z [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 [Naive 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 to the following address: [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]. / // Z Signature of Applicant . Print Applicant Name 41;11- 6 -201 --( Date wirl-n "' Q` P, s=' bbl -�d 1-5 9 (2� / � � a y n bj- 1 RECEIVED JUN 0 6 2011, COMMUNITY DEVELOPMENT