HomeMy WebLinkAboutCLE201400150 Legacy Document 2014-08-18N4 ,) ),e d
Application for Zoning Clearance
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CLE # Z c) I H — 150
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OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS
Check # 9 Date: 1( I
Receipt # 4(o-7 2 G� Staff:
PARCEL INFORMATION -7 /
—3-- 7 A Existing Zoning Co✓►� (�Q� �i�
Tax Map and Parcel: I lacm w�Q
Parcel Owner: ?,cr 't n 0�J)o -0 -( <—":�
Parcel Address: 503 -Fn (J 11' D)-V ?-r Dr 7City date
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? j11�l
Address :3070 u� e (o r° (- P . City c State A Zip?2 t
Office Phone:' q k 1 Cell # Fax # E -mail Ib -si-A W dea n P
ya coo , co ryl
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: (� �f� Y1P,%'S _l..�'1 ' Pf3 �Y1lP1f? r c� U ('
�s`L' ��n � 1' �a �
Previous Business on this site
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: E dv r n -(46 r-, T Div -. f' r. rr n 6n e . e en rv,/
rbz-. bra
*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.
Eta w 'D
Signature - Printed
APP INFORMATION
,ROVAL
[ pprov -as proposed [ ] Approved with conditions [ ] Denied
[ ] B ow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ o 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
t
Intake to complete the following:
Y/N
Is u n LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi re 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 o public water?
If private well, provide H lth ent form.
Zoning review can not begin ntil we receive approval from Health
Dept. FAX DATE
Reviewer to complete the following:
Square footage of Use: e-%
J' N Ar.
Permitted as:
Under Section:
-Tr
Supplementary regulations section:
Parking formula:
Required space
Y/ (�
Circle the one that appl' Ite o be verified in the field:
Is parcel on septic or ublic sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # C�a� Inspector : Da
Y / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Viol i ns:
Y/N
Ifs st:
Proff rs:
Y/
If so, st:
Var'
Y N
If so, ist:
SP's•
Y/N
If s , ist:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
I
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, dv cs LeeenL uca6
[County application name and num r] r 1.-�r�sv
was provided to Prrr,
(r) cJ mod' the owner of record of Tax Map
[nameI I of the record owners of the parcel]
and Parcel Number 50 :� F u � C(- --) ,e r & J - - lA by delivering a copy of the application in the
manner identified below: G v[ q Z v A- ZZ- ,Tc 3
Hand delivering a copy of the application to
[Naive 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
_A/Mailing a copy of the application to PL-rn h Q,) ( �✓
[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 G to the following address:
Date
Dr, Cbo4-- k�v i �Ge
l �
[address; written notice mailed to the owner at the last known address of the owner as shown on 7 /
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of Applic#lt
Print Applicant Nam
Date
4yr