HomeMy WebLinkAboutCLE201400161 Legacy Document 2014-08-29Application for Zonin Clearance
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CLE # 14 - up
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 2W Date: S ✓��'
Receipt # Staff:
PARCEL
Map and Parccell:J) Cp /%, Pgl-f / / d 6 / - QO -Iy° G� Existing Zoning Q/� q / /0r D PIlvlCi
Parcel Owner: J 4,1 1)2Uet D 1� ►'i�� ✓l�
Parcel Address: b1 �- r 500h 3 City OWA1164V1lb State V Zip ZZ/! �01
(include suite or floor)
PRIMARY CONTACT ` j
/?%%l!L` LcL,
cJ�r7
Who should we call /write concerning thisp �
rroject?
Address : Fi )e0cVY ar Or, 3 City Chl(110 I 'VA State V4 Zip Ufal
Office Phone: ( ✓ !) 37/ Cell # Fax # E -mail J! Vfid — ✓a- eyaAey, CUI�bI
ea nne. Lynch e, cem.fYa( oc,ear'15. t o"9
APPLICANT INFORMATION
Check any that apply: of ownershipc� Change of use of name New business
� p `Y ,,Chang(ee /Change
Y�
Business Name /Type: doy 14 J
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, nd any dditional information that you can provide: eYYplpy g< S aghd l'Y1 LAI oa -el-J
,
*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
�bylthem. _
Signatur�''' L yplc t
jgL; +wr dow /'ed
crs.
Printed ,
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
Zoning Official �i/� 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
Intake to complete the following:
Y /(:�2
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y/ZI
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 pfflgic wat
If private well, provide 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 septic o ublic sewer
Y/P
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/Q
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:
�
/N nn
ermitted as: Ce
Under Section: `LS' Al 2
Supplementary regulations section:
Parking formula: % ^'
�b /v
Required spaces: 7
Y/
Items o be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/6
If so, List:
Proffers:
Y/A
If so, ist:
Variance:
Y/ v
If so, List:
SP's:
Y/
If so, ist:
Clearances:
SDP's
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, 1MY? ae,,gl--nf L CLG"V
[County application name and number]
was provided to J I J —De'v e,109v V-4 the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 061 M D -00— I y- qD 3 C U 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
L/ Mailing a copy of the application to J 't � —L) P-,U �- �p mu
[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
j I j T)Zve( ®o,rneVcl ; �Szq Se, will e �c�, 6t, i1d1�d Vr`�e U/� zZr4 Z
[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],
signa ure of Applicant " `j, I
Print Applicant Name
g. 23.201Q
Date