HomeMy WebLinkAboutCLE201400089 Legacy Document 2014-07-08Application f ®r Zoning Clearance
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CLE # 2.01 q " q f(
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Checic # 07 Date:
9�s
1�12
Receipt # Staff: ng
PARCEL INFORMATION
61 13 I � Q -Avejpo
Tax Map and Parcel: / Existing Zoning
Pal-cc] Owner: }"10 Ipa h� 1. vl r ta�eS
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Parcel Address: �1 � R� � �. L. City ',..-V�r�r 1�AS V1'1IX. State V A ZipQ2.g0
(include suite or floor)
PRIMARY CONTACT /
Who should we call /write concerning this project? 1(/�4� �A(4.a -�
Address:.2<j9y 41,A561,\ Dy- City C 164'(SV4�State Zip 5
Office Phone: (�f �73-��ylP Cell # Fax # E -mail3 �%� (�[�rG�C ff% G • CGS
APPLICANT INFORTqATION
Clieck any that apply: Change of ownership Change of use Change of name New business
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Business Name/Type: 1 r' l ✓A, ��!' 1�~ ��. 'G �'Ll a�'ID P [11L/f �GIS�r'ch S5 t/G✓C
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Previous Business on this site
Describe the proposed business including use, number of employe s, number of shifts, available parking s )aces nu�!ber of
vehicles, atidl any additional information that you can provide: S><��ft�t� : 2J tp Pd , ,Lc hr� �r� GUnlar
*This Clearance will only be valid on the parcel for which it is approved. Wyou change, intensity or move the use to a nc;w location, a new Zoning
Clearance will be required.
1 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 th • cst ol'my kn pledge. I have read the conditions of approval, and I understand them. and that I will abide by them.
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Signature J Printed - llf r^l'+� (a joy'
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, xl 17.
[ ] 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 /9 ho ly
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
-4--
Intake to complete the following:
Y N
Is L ' n LI, HI or PDIP zoning? Ifso, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there b food preparatio .
If so, give ap ealth Department form.
Zoning review can not begin until we receive approval fron Health
Dept. FAX DATE
Circle the one that applies Parking fo•nnila: P 56 Z/7S
Is parcel on private well or )u�epartinpeni il
If private well, provide Fle1 .. form.
Zoning review can not begin until we receive approval from Health Required spaces:
Dept. FAX DATE
Y/1
Circle the one that applies Items to be verified in the field:
Is parcel on septic o • ublic sewer
Y
Will be putting up a new sign ofany kind? If so, obtain proper
Sign permit.
Permit # Inspector : Date:
Y N Notes:
Wi th e be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: '?— 4),a d
/ N I ..
Permitted as: I'i n
Under Section:
Supplementary regulations section:
Zoning to com lete the followin :
Violations:
Y /(�)
If so, List:
Proffers:
y/ '•
If s st:
Variance:
/N
I so, List:
SP's:.
Y/
If so,~ ist:
Clearances:
SDP's
Revised 7/1/2011 Page of
0
P
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
Phis form must accompany Zoning applications (Home occupation, Zoning Clearance, Zonhrg
Acbninistrator Determinations or Appeals, Sign Permits, Building Permits) if the application is Trot the
owner.
i certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number by delivering a copy of the application in the
manner identified below:
,t L_ 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]
Oil
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]
Oil 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].
x. k-\�l
Sig/natur -e of Applicants
"Print Applicant Name (
K 5^ 5- fit!
Date