HomeMy WebLinkAboutCLE201400109 Legacy Document 2014-06-18Application for
CLE # 'Ll
Clearance
OFFICE
PLEASE REVIEW ALL 3 SHEETS Check # Date: `1 t ` 14-
Receipt # Staff:
PARCEL INFORMATION l C
Tax Map and Parcel: 07 O 0 1 UO —0a - U/ C 9 Existing Zoning �T
Parcel Owner: 6'r T' �iv(/eT�i� r,✓�J" LLC
Parcel Address:` S P�,��,s 7 ai ie C City AState VA Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? L%Ied
Address : %� s �,e-,c os . , -U I& C City C Dui t/i State P�A— Zip-)
Office Phone: ' 91tell # Fax #
cj C6ie � etr- ev y
APPLICANT INFORMATION
Check any that apply: /� Change of ownership Change of use Change of name New business
Business Name/Type: Ca oo a lr^.- t-It r ii WV U �G
Previous Business on this
Describe the proposed business including use, number of employees, nu ber of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: e �' c //P �4 t1"
"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 to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed C5Oa�t6e.
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. I
[ ] This site complies with the site plan as of this date.
Notes:
Building Official
Zoning Official
Other Official
Date
Date
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5532 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
a
a
Intake to complete the following:
Y/N
Is use in LI, HI orPDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YIN
Will there 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 I
Is parcel on private well r publicaA n r?
If private well, provide lth Department form.
Dept. BAY. DATE
Circle the one that appli
Is parcel on septic or lic.sewe
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 fn ommnlpta tha fnlinwina!
Reviewer to complete the following:
Square footage of Use:
9/N- n
Permitted as:
Under Section: L . 2 •'
Supplementary regulations section:
Parking formula:
VA
be verified in the field:
Inspector: Date:
Notes:
Violations:
Y /1�
If so, st:
Prof rs:
Y
If so, List:
Vari nce:
Y/Y
If so, List:
SP!s•
Y/(
If so,Zist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
n ,
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) iftlte application is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to (3P'� tQ /.tit/ p�J G� the owner of record of Tax Map
fnamefsl of the record owners of the Darcell
and Parcel Number �C y' by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to
[Name of the record owndr 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 T,�/ �t r'f` �ic- t/c's�i�r �.�-�s Z'G G
[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 a tity.
on G to the following address:
Date
[address; written notice mailed to the owner at the last own address of the owner as ihown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signatur of Applicant
Print Applicant Name
Date