HomeMy WebLinkAboutCLE201400146 Legacy Document 2014-08-14Application f ®r Zoning Clearance
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OFFICE USE ONLY
Yy r Date: l
PLEASE REVIEW ALL 3 SHEETS
Check#
Receipt # to l Q Co Staff:
PARCEL INFORMATION -P eknnzck Ap^;
Tax Map and Parcel: 45 b(9[1 ML) - oo`1'a,"toli9 Existing Zoning M,6x -2CQ ConnWwrC.LoA
Parcel Owner: --Gn.j tAD1150tj T-1e- DycG. 'Xoy1 QVDL42)
Parcel Address: �Do1� kJ 1 km� C4_ C� City VI�lJIY JpWeQ,r I�V�. State V 11rgl Y11 Cn Zip 71 2�0�
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PRIMARY CONTACT ,
Eri
Who should we call/write concern_.ing this oje�t? e12osene,
Address: 6 L D L'n City U\P e wtftsVI I4. State V t'S t arl l c, Zip 1-9 F
Office Phone: (_) Cen # q3y °c{D9' l4aSFax # E -mail UICU @`K2Dilb-ejl lk
OLOAV1c.1 4uko. com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: l� r a M W'e h'Lx 7]L)Q6C.Q- C'4V�
Previous Business on this site C- v t l t ►3 i k2 o.Acl �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: MoS44 t ned c p± ActcjA I- ni, e- [5 / wqq
cx 'e w V Ok'ys 0- week . �1 aik:v�a Fo( Styolen }S + "ns Yuc -+Of s . No c 01y%P 411i J
MA.ub-p— i1k '* -��P� e% -yv\.L dA. n'ac C , loa5Se5.
*This Clearance will only be valid on the parcel for which it is approved. If you change; intensify r move the use to anew location, anew Zoning
Clearance will be required.
I hereby certifytliat I own or have the owners permission to use the space indicated on this application. I also certily that the information provided
is true and accurate to the best of y knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. ,
Signature a Printed 111 C� ��j� ilk
APPROVAL INFORMATION
[V Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] ackilowprevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, xl 17.
[V o physicil`site\spectionleas 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
iLl
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
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Intake to complete the following:
Y
Is 0 LI, III or PDIP zoning'? If so, give applicant a Certified
Engin91're er's Report (CER) packet.
Y /
Will be food preparation?
If so, give applicant a Health Department form.
Reviewer to complete jthe
f % ollowing:
Square footage of Use: 1 1 Ara,
�ern�tt,d as: sry� i =*4
Under Section: A • a • I -ni ( Lf -
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies Parking formula:
Is parcel on private well or p lie ),Orm
If private well, provide Heal ai .
Zoning review can not begin until we receive approval from Health Required spaces: j
Dept.--- FAX DATE -- - - - - - -- - -- - -- - - - - - -- l - - - - -- - - - -- - - --
Y N /Circle the one that appl es Iten o be verified in the field:
Is parcel on septic or p blic sewer?
Y/N
Will you be putting up a new sign of any kind'? If so, obtain proper -
Sign permit.
Permit # 61 "� /' 7nspectar : Date:
Y / N , I f Notes:
Will there be any ne cvS onstr-uction or renovations? 1Z
If so, obtain the proper Permit.
Permit #
Zonin6 to complete the followin!:
Violations:
Y/N
If so, List:
Piro ••� s:
Y N
If , ist:
Var' ce:
Y
If so, ist:
SP's:
Y/N
If so, List:
ClearancmVP� n�
°
SDP's
Revised 7/1/2011 Page 3 of 3
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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 notthe
owner.
I certif} that notice of the application, 61bcs \w l� 6 1xno\
[County application name-And number]
was provided to Tony U5% 11bo n 1111e, OVo' on Q�n� the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 45 061 lf` b oi)-i a - OoI A) b} delivering a cop y of the application in the
,manner identified below:
Hand delivering a copy of the application to D Va.��L-x-) Cro�f
[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 tC1 2J �k r \,LA
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
Date
to the following address:
[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].
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Signature of Applicant
Print Applicant Name
Ruo, 4 , N
Date