HomeMy WebLinkAboutCLE201400166 Legacy Document 2014-08-29Application for Zoning Clearance
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CLE # �ZO - l (o y
ty,
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # S3) 30 Date: `b 2-7h
Receipt # Staff: Dif
PARCEL INFORMA,TIO 'f L l ( �j
Tax Map Parcel: (,p( "��j —�i Existing Zoning ��U qC4 w '
and V �f C�
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Parcel Owner:
� � DU �� i�,(�l��l+��i� -'' City �� ' t ate Zi �(
Parcel Address: ����� p&g p
(include suite or floor)
PRIMARY CONTACT --�-
17MA
Who should we call /write concerning this project?
Address 1�5� %2���!ili(/Li F�� -I JCity SU6I State ZipZl
: .ir>�e�()
Office Phone: (1) "l LS (! o Cell # Fax # eMTS E- mail+k i cL (Qwiao04e,�(
APPLICANT INFO ATION
Check any that apply: V Change o f ownership Change oAfrus(e� Change of name New business
Business Name /Type: OAMO S c 6 1 V� %0 WC
�i --
Previous Business this 6, 4--� M W j2B
on site r�
Describe the proposed business including use, number of employees number of shifts, available parking spaces, number of
(d ll, , -
vehicles, and any additional information that you can provide: l !AA L
UNA� ill
*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 he best of my knowledge. I have read the conditions of approval, and I understand them, andd that I will abide by them.
Signature Iw Printed /V'Io r
I�
APPROVAL INFORMATION
Approved 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 V '�-F
Zoning Official Date 9 Z9: 16
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
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there 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 or. lie ter?
If private well, provide Hea Ike rtment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or p is se
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:
Reviewer to complete the following:
Square footage of Use: ! 3,)
0/N
Permitted as: Zfb ec 1-<:LJ11%111rj
Under Section:
Supplementary regulations section:
Parking formula: / P /,D;, 4rc-i
Required spaces:
Items to be verified in the field:
Inspector :
Notes:
Date:
Violations:
Y/ n
If so, ist:
Proffers:
Y /jN�
If so, ist:
Variance:
O/N
If so, List:
SP's:
(b /N
If so, List:
Clearances:
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 not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to ILA l���y(� IVU'd T I sy�ll�d1��`rCif �[�of record of Tax Map
[name(s),of/ thfie record /owners of the parcel]
and Parcel Number l i �'U V �_ I b/ 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
V Mailing a copy of the application to d 1/C R e`/f_61s
[Name of the record own r if the record owner is a p rson;
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 21 to the following address:
Date I
(a
iVle�'�
ov
[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].
Signature of A . pl' ant
Mo
Print Applicant Naphe
Date