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Home My WebLink AboutCLE201400157 Legacy Document 2014-08-25Application for Zoning Clearance CLE # OFFICE U �y1LY PLEASE REVIEW ALL 3 SHEETS Check # p� Date: Receipt # Staff: PARCEL INFORMATION I _ C 55e- Tax Map and Parcel:: I Existing Zoning j Parcel Owner: 1 el • orc1 n 1 " /OU ►7 O C: 7 �L t �,Q Parcel Address: � 1lo 010 Tral� Dr. City tb' ¢.. State VY' Zip zz93Z (include suite or floor) SA e_ .`ZO PRIMARY CONTACT ` r Ill 2C' V \. Who should we call /write concerning this project? a City C��o SuN_ State VIA Zip ZZgd Address Office Phone: L_-- Cell #/% OO�LFax # E -mail 06CGoc1t \6 Q APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: ri zAt C c �a c—OL l co Ll-�- Previous Business on this site Describe the proposed business including use, number of employees, nlAroer of shifts, available parking spa es, number of vehicles, and any additional information that you c n provide: 6 SG ce► Z e i an *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. 1��f�1��' ( U L Signature Printed AP OVAL INFORMATION App ed as proposed [ ] Approved with conditions [ ] Denied , [ ] ckf! prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117. with the existing [ o physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance 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 lievetopmeni 401 McIntire Road Charlottesville, VA 22902 Voice:. (434) 296 -5832 Fax: (434) 972 -4126 r' Revised 7/1/2011 Page 2 of 3 i Intake to complete the following: Y/ Is us I, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. 1 Y/N ill there be food preparation? If so, give applicant a Health Department form. Zoning review can n be i until e rec 've appr al from Health Dept. ATE Circle the one that applies Is parcel on private well or lie water? If private well, provide H It%[ar ment form. Zoning review can not begi •until we receive approval from Health Dept. FAX DATE Circle the one that app li Is parcel on septic o ublic sewe •) Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ZOnin9F to com lete the following;, Reviewer to complete the following: Square footage of Use: u2A Y )/ N /J- rmitted as: ' Under Section: aV r/�e – m Supplementary regulations section: Parking formula: o S Required spaces: f L a ` 11, , 'k 'Al fit it Y /' u ` Items o be verified in the field: Inspector Notes: ate: Viola ons: Y / #-q If s "st; offers: Y X N o, List: Va an e: Y If so, ist: SP' ' Y If so, ist; Clearances: SDP's L D Revised 7/1/2011 Page 3 of 3 k� J V G b 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, [County application name and number] was provided to t Y `ar& A0VvXkg1,n 6"' s the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number I10 4 "Cat( DC' �Z O by delivering a copy of the application in the manner identified below: ZZg3,�7 Hand delivering a copy of the application to Mar-(, A Vw�a(,A [Name of the record owner if the record owner is a pp�� person; if the owner of record is an entity, identify the recipient of the record and the recipient's i RA I title or office for that entity] on CDate � a0 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]. -- IA�-�- Sig tur of Applicant GVKUE-1 S. U�( Print Applicant Name Date Application for Zoning Clearance � °`�`t1.� °`� CLL # d OFFICE U 'LY PLEASE REVIEW ALL 3 SHEETS Check 9 Unto; Receipt # Staff; PARCEL INFORMATION I , 5e "" 4 C�.. Existing Zoning) 'I'ax Map and Pnrcel; 15 n �n 1 M Parcel Owner; 1 Y IG rGV1 o t; I'L (t (U Parcel Address: �lo 61� Tfo,ll Dr. City -----State Zip MIR. (Include suite or floor) <'kt.`'LO PRIMARY CONTACT `` ��t Q),ra Who should we covivrito concerning this proiect? i11 ((A W U s. City cw' 4vtl' Stnte VA— Zip Zz 90 Address ; ae.`1C,r Office Phone; ( - --°°'" r" Cell nx # E -nlnii UCCoU66 (am tts► 4S APPLICANT INFORMATION Cheek any that apply; Change of ownership Climi e.of use Change of [lame New business Business Name /Type;L G0 t d C�ia L LLC., Previous Business on thiss4te \S Describe the proposed business including use, number of employees-, n1 #n er of shifts, availiblepai•l ing spa 's, nunibei- of vehicles, and any additional information that you c 1 provide; e-A ki VI *This Clearance will only be valid on the parceTfor which if i`s approvad� IEy °ou "change,`intenslfy o inosie tfie "tis� t6 a`t1�'�`16c2tion; a'lrety Zilning ' Clearance will be required. I hereby certify that I own or have the ownees.permission to use the space indicated on this application, I:akm certify that the - information provided is true to tl c Best of my knowledge. I have read the conditions of approval, ,and I understand them, and that I will abide by them. and accurate Signature Printed 1J .An -IV\ ` U Cl -L APPROVAL INFORMATION [ J Approved as proposed [ ] Approved with conditions ` [ ] Denied [ ] Backflow prevention device g0or current test data needed for thissite, Contact ACSA, 977 - 45,11, x117. [ J No physical.site inspection his been one for tbis,ajealat>ce There ore, it is not a determination of compliance wiflr the existing l ( ?r r d. J + ,. site Ian. �' t ff [ ] This site complies with the ItepI h as of�Itls date, F 1 aiti Notes., �. Building Official Date Zoning Official Date Official %vL- �`'-`�--. /% S' Dnte' Other U01111ty 01 AII)cninl•Ie Leparuneq+ v+ %.wninun %,y uurcl„1Jluwl 401 McIntire Road Charlottesville, VA 22902 Voice; (43 4) 296.5832 Fax: (434),972-4126 Revised 7/1/2011 Page '2 of