HomeMy WebLinkAboutCLE201400155 Legacy Document 2014-08-27m4l; Ile C/
Application for Zoning Clearance
CLE ST
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
�22 Date: q)j5jj q
Chock # t604'
Receipt # q 1 -, 7(cq staff: E562,
PARCELIOP�l AJI'101�00 Existing Zoning P0
Parcel, ()C 0 ()o _ 0 �,:51 C) uk0-11�0 'pMW
J."I 7
arcel.
Tax Map and I
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Parcel Owner: G',lSkOC-SS VW41- L_LL
ParcelAddress-A550 \J10LA in Cif t\WL1-0_TTj3Je State VA zip��WICQ
— y
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? P—VCW— Vj
Address :'5)_cA 0604Kcu'je�l N10 City ALI ry4xLirj ,t, „ \,A 223OL-to Zip
Office Phone:( '�) � 2)83)&1, # Fax rh*Vee.h24. corn
APPLICANT INFORMATION
Check any that apply:_ Change of ownership _Changeofuse Change of name VNew business
Business Name /Type: FOCOSO-Jicc
V-1-U4101-11i 99(�,
I
Previous Business on this site
Describe the proposed business including use, number of employees, number ber of shifts, available parking Spaces, number of
-additional information OM-01a SPOTS k -2-
vehicles, and any that you can provide:
\YQAQAA--,'S . KAOr” - C (6 f M - H 0M , 0000 M`jl V-17 CAtr AX Kb 9- — '5-65t V_!7Q(:7 CP
V-4,5u,N1 %_ 4i
*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 rue 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.
Si(n:atur: - - .Printed
APPF',.0VA3 INFORi`:'IATION
�Approvcct as proposed Approved with conditions Denied
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 plan.
[ ] This site Complies with the site plan as of this date.
Notes:
Building Official Date
zoning Official Date �-.-12"kwy
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
yi P07
Intake to complete the following:
Reviewer to complete the following:
(2) / N Square footage of Use: AW
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. O / N
Permitted as: ,. -AA , t,e A��S rJ f C5�
Y/ O- r- �-ry�°
Will there be food preparation? Under Section: 2
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or }�dbl�ater.
If private well, provide Healt Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies.
Is parcel on septic public s w r?
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 #
Zoning to complete the following:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
Viola ions:
YI
If so, List:
Proffers:
Y/15
If so, List:
Variance:
Y /O
If so, List:
SP's:
Y /(9
If so, List:
2-o II-.7= D
D
Clearances:
SDP's
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2.1-,�,c
Revised 7/1/2011 Page 3 of 3
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, FVODS�Xw j" Nf-A�
[County application name and number]
was provided to
Sr`►cN' � 4vStN��s p(�- �c
[name(s) of the record owners of the parcel]
the owner of record of Tax Map
and Parcel Number -' Oct 0; ,00 " cl) 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 5�c`"� 0`tiS ic�-S� (A ML p I Uk ( S1 4W t( 11 ��
[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 C&l Itil I L'1 to the following address:
Date
q01. st-icpj \-Ak LL ►,N Q 4 211111
[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].
g of Applicant
q-kC N)R, (-) vowrE
Print Applicant Name
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Date
Foodservice Technologies, Inc (T /A Tech -24)
1530 Viola Way
Charlottesville, VA 22902
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