HomeMy WebLinkAboutCLE201400147 Legacy Document 2014-08-19Application for Zoning Clearance SFr
ORRICE iJS Q
PLEASE REVIEW ALL 3 SHEETS Checlt # l-� Date:
Receipt # Staff. _
PARCEL INFOR IATION lk ,� 54�-e
Tax Map and Parcel: 1 ar 2� "C Existingzoning 5� /? �-
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Parcel Owner: t dor #K Jan k{��r�snn Yr tC
��rr �IX- City �j t Cc�. State„ V%� Zip'Z�Q2t{
Parcel Address: z� IIAn Y
(include sulte or floor)
IMMARY CONTACT Qx �-�m / ' a e(-
--
N,Viio should we en1I /write conceraingQthis project?_ r�
Address : ZDoo ` �a 1'� `Y �' i State ^ Vj Zip Z2. O'2
Office Phone,
[7��Cell# silFr►E •• Bnx #^ E- maitGll2x s���lMlv►C�.Co�7
APPLICANT INFORMATION
Cheeis any that apply: Change of
Business Nnme/Type:
Previous Business on this
Describe the proposed business including use, number of
vehicles, and any additional information tit
Pty'91t can prc
Change of use Change of name New business
number /off shifts, available parlc'
�f,�;Lg spaces, number of
TT—his Clearance will only be valid on the parcel for which it is approved, Ifyou change, intensify or move the use to anew Iocation, anew Zoning
Clearance will be required. '
I hereby certify that I own r n the s permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to t in dge. I have read the conditions of approval, and I understand them, and that I, w111 abide by them.
Signature Printed�_t,�'�rn��'
APPROVAL INFORMA41WN Denied
rl]
Approved as proposed [ ] Approved with conditions )
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 plats.
[ ]This site complies with the site plan as of this date.
Notes,
Building Official. Date ITS — J
Zoning Official Date
Other Official v .fl G� Date --V—/
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax.- (434) 972 -4126
.,
n y Revised 7/1/2011 Page 2 of 3
tit i.�t 41 1:.• 1.Y 5 �:^ •f l.
.F
Intake to complete the following:
Reviewer to complete the following:
Y / N
Is use in LI, HI or PDIP zoning? Ifso, give applicant a Certified
Engineer's Report (CER) packet.
Q / N
lit there be food preparation? r /��
If so, give applicant a Health Department form. V
Zoning review can not begin until we receive approval from Health
Square footage of Use :�yy.
!�
F /N
Permi#ed as:
%6 %G
Under Section: S
Supplementary regulations section:
Dept, FAX DATE
Circle the one es
Is parcel o rr a e r public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Parking formula;
Required spaces:
Dept. FAX DATA
Circle the one that applies
Y/
Items to be verified in the field:
Is parcel or public sewer?
Y/N
Will you be putting up anew sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector : Date:
X ! N
Will there be any new construction or renovations?
Notes:
SDP's — `~- --�.
if so, obtain the proper Permit.
Permit #
.,. _ t_,t___.f
Z'onm zo com rule tyre iurrurvrii
Violations:
t�1N
If so, List: I
P roffe '
Y/
If so, List:
Variance:
Y /O
If so, List:
SP's•
Y(
If so, ist:
Clearances;
SDP's — `~- --�.
20 i���f9
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zonir :g applications (Home occupation, Zoning Clearance, Zoning
Administrator Determinations orAppeals, Sign permits, Building Permits) if the applicatlon is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 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
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].
&A-,
Date
...........
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