HomeMy WebLinkAboutCLE201400118 Legacy Document 2014-07-02Application for Zoning Clearance
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CLE # 2014 - 16
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OFFICE US ONI.�j,
Check # `U`1 Date: Cp ° 11 ` 14
PLEASE REVIEW ALL 3 SHEETS
Receipt # 5L �, Staff:
PARCEL INFORMATION , // j
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Tax Map and Parcel: �(p Existing Zoning l Vf mr� (/&1d/0^'l2_n1
Parcel Owner:?
Parcel Address: Q. &x D .J 7 City �J /` State / " C, Zip (271
(include suite or floor)
PRIMARY CONTACT
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Who should we call/write concerning this project?
Address : 1 �00 1�rd•C S(JrinSS )C) I City �(�c,r�o7ieSV� �1 � State 11 ZipX70 2
Office Phone: Ci6 02 - ?aS Cell# "0 -qtV -Q %Fax# y3%- 2e.7_$4V3E4ai1 p( V�� urSe� �AQ_rin .<<rrr
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name /Type: 7� ��5 ✓� a,r�T�on
Previous Business on this site Ge //L4 111(^ / "( �`1`�rt�, �5 .- �n�JZf ✓�c,`r��nci I! ''" n C
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
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vehicles, a�Il /d any additional in ormatio(n, that you can p1 / rovide: n ril¢�Qr; n ti f M e-_ vee
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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 r ve.the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and acc to to the b s my owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatur Printed
APPROVAL INFOR ON
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:
Is/
1s u e m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /l£lf
Will ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval fi•om Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well o public r�
If private well, provide Heat epa ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic ublic sewer?
Y /
Wil u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
W rere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
9 / N mitted as: �`:, � t) c.e—
Under Section: �=I(� . 41.
Supplementary regulations section:
Parking formula:
Required spaces:
YT/707
Items to be verified in the field:
Inspector Date:
Notes:
Violations:
Y/Q)
If so, List:
offers:
,' /N
If so, List:
Varia ce:
Y /
If so, ist:
SP's:
Y/N
If so, List:
Clearances:
SDP's
f307 —
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, Z a A T 01,n C,
[Cot ty application name and number]
was provided to F C D o , uG L the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 0 7 6 � � —)d4 by delivering a copy of the application in the
manner identified below:
(� Hand delivering co of the application t 7 6t n c7 A�)A al C'
g copy o 6TJ
[Name of the 4ecord owner if the recor` 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 6
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].
Signature of Applicant
olwFA A �L &, re,
Print Applicant Name Ij
Date
Dropbox - Mill Creek Office Layout.pdf
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https:// www .dropbox.comislujt60lbgyvdpb551 Mill %20Creek %20Office %20Layout.pdf 6/19/2014