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HomeMy WebLinkAboutCLE201400116 Legacy Document 2014-06-20Application for Zonin Clearance J.1 + `; "'gym CLE # 20114— ) '' u :A 'S PLEASE REVIEW ALL 3 SHEETS 1Receipt#_9_G6,S") OFFICE USE ONLY Check # -26o 0 t Date: (o) 1 Staff- PARCEL INFORMATION <�l Tax Map and Parcel: C) 14lp [3 Lj CDC) (DUO i7 900 Existing Zoning (XJ Parcel Owner: JA -zV- a L-Lc To" 3-t sS Ltp xrz � i'Y)CAAna-ae -c i ^ ���1 '* )o5 Parcel Address: 171 -7 � I I M v,,�Pl'V�/LX=G►' R V, City (` �i � �r Ic *e-yt J1eState V 1- Zip 2-9-9 1 I (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? —S-herie -S-her Pi crpq y- R csS P i r)12_ s Address : ,� 330 14-n i2�-'x CJo R),,ceS-� City Amrbou ►^Co'11(> State ,VA- Zip X92.3 Office Phone: i r�C #yq� -LFax # E -mail S�'le�iI�S Io +rrc APPLICANT INFORMATION Check any that apply: Change Change of use Change of name I�New business p n `of-ownership Business Name /Type: g/\,©lAnd l_Y Xarlof'-esyi he- ' E I hMess KJC�bby -krn ll E;1cloi1 r Previous Business on this site-` 'a ya' e- r Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: F ( i1 r i ` Q00- Cent-aGA k..1rxboxinCA ')cerusq i --;� 1-!Lll l�d I to+cd S oei riE., *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 A&fL"c== Pr inted `- 6 ein1l. p j n ce C APPROVAL INFORMATION [ I 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 *:. c. Date ' (-t f Zoning Official 141214 L 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 _i t •C-q t.l � cl e, Intake to complete the following: Y N Is u ins I, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/N 0 W1 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 r public water? If private well, provide Hea epadme form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septi r public sewer Y Will you be putting up a new sign of any kind? If so, obtain proper Permitnnit. `_A S SPpa&� Permit # Y� Y/N Wilt ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to comnlete the following: Reviewer to complete the following: Square footage of Use: ) Z 7 Z P rmitted as: Inky :FT 11 Under Section: Supplementary regulations section: Parking formula: i a 5 I F' Required spaces: Y/N Items to be verified in the field: Inspector •, Notes: Date: Violations: Y/N _ If so, List: kfA Pro Y /(NI If so, ist: Vari If o, SP's• If o, List: 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, Zf?()! Intl [Coup application name and number] was provided to - jl [ J , <�[�S 115;S �, the owner of record of Tax Map [name(s) of the r�wners of the parcel and Parcel Number 6 DO©QO0 $(fib 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 Mailing a co of the application to j A Z l� ivr �-�'' j rn ts eSS L„0 . er [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 �3. �" to the following address: Date , 1 s 0135 e) V [address; written once 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]. , �j� -.e-- -, (?De A-t-11 i ature of Applicant Print Applicant Name (6 - 6 -/ �( Date s 5' ..J o V S Q 1p v� c c� Q 4 ?y m m rn