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HomeMy WebLinkAboutCLE201300281 Legacy Document 2014-07-07� 20 13 - 212. Application for Zoning Clearance CLE# 2013 -2,. I OFFICE QNLY U I '; �L PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: ,L PARCEL INFORMATION Tax Map and Parcel: 0 <%lt16 --U 0+/2 — OQ Existing Zoning Parcel Owner: LA L V . D Pa�cel 2ddreso� / D . aj P CT- City CNA/tl,D State \1A Zip (include suite or floor) PRIMARY CONTACT t© Who should we call/write concerning this project92 t Address : ICJ a A/Z t/ CDII "� City �A L`i -q AA ,Zrp �• �j Office Phone: L__) Cell it baS- 4y7 7 Fag # E -mail - o u APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New busin ss Business Name/Type: A ICJ Previous Business on this site twig 0 N Ea I r Jls Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number o vehicles, and any additional information that you can provide: 5 O W 1 .5 *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 Zon ng 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 W gg I/ tW /lv PIQjti' jF APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denicd ] nacl�ow prevention device andior current test data needed for this site. Contact AI�SA, 3'17 -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 r Dat e Zoning 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) 9724126 Revised 7/1/2011 Page I of 3 t ct" ,'I l�. c,; Intake to complete the following: Y/6 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. �/N ill 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 Reviewer to complete the following: Square footage of Use: 2 6'7 a� / N �`/,� Permitted as: P� Av1 'CIVAi k Under Section: Supplementary regulations section: Ciroie the one that applies Parking formula: G// 7S Is parcel on private Well o public w er? If private well, provide H artment form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAXDATE Y /(— Circle the one that app Items to be verified in the field: Is parcel on septic or s er? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector: Date: V1 Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Znnino to emmnletF Ap fallnvvina- Notes: Vio ations: Y/ Tfso, ist: Proffers: j/N If so, List: Variances l/N If so, List: I/N If so, List: Clearances: SDP's Z Revised 7/1/2011 Page 31of 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. ALg>r��LE CtunlTy I certify that notice of the application, A P� U &A %! b n1 Fy l� Zy. J! A16- CL£A21 cF. [County application name and number] was provided to F D 1; AA L kGft L7 N 1I N✓C5-rA11 : ttie ov ner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number -0b/ /L! 0 -- OD OP t'-6 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 /PROP Mailing a copy of the application to FAQ ROPP KS- W0,9 L D ., LLC [Name of the record owner if the iec d owner vner 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 1I 11-b�� to the following address: Dat6 [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 1 this requirement]. r K 5140P( 5p WOP,1,0 7 1Le FFOEIZA . REA.LTy WV&57- j1-15jVr TkUs T [IAAco CAS- JEV ERsdli �Tg, T ROt —KVt L-L-E � AD X852. - 4 O r ATOJ Ao6g1Q i�� & e-, Signatureof Applicant Print Applicant Name Date #17.119 ,