HomeMy WebLinkAboutCLE201400171 Legacy Document 2014-09-04Application for Zoning Clearance
Application CLE,#X14-171
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PLEASE REVIEW ALL 3 SETS Check It Date:
01
Receipt tt— Staff,—
PARCEL INFORMATION
Tax Mapand Parcel: s)5600 - OD-00 - 1(000 Existing7 (I it I'll
Parcel owner:
Parcel Addrcss:,5'Tp o o-i, oh A!
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project.,
Address :-taf—A P, A city State
J�, zip Jkw
Office Phone. C
Cell 49% -3Y7- Mq,-a1 # E-mail
_APPLICANT INFORMATION
Check anti that apply — Cininq of ownership Chmige of use Chaw�Ieof name New business
. . ......
.
Business Name/Type,
Previous Business on this ;)o.-
I Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
`This -Clcarancewillonly be valid on the parcel -for -which -it is app—roved. Ifyou 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.
Signature
. .. ....... . Printed
APPROVAL INFORMATION
.54 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
Zoning official
Other Official
Date a
— ( L
Date
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: R
Reviewer to complete the following:
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Square (bota,,onfUse:
ixusei, Li, 8lo/9D[Pzoning? 1fxo` give applicant uC^rtihvd
| Engi000/,Report (CER)p:okcL. L
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Ifyo, give applicant a Health Department fono }
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Zoning review can not begin until nv receive approval from Health S
Supplementary regulations section:
|Dept. FAX DATE
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Parking formula:
|b parcel oo private well
Zoohu"b» complete the [oOmriu
Violations:
soIf , List:
If so. List:
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CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Horne 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 _ _ the owner of record of Tax Map
[name(s) of the record owners �f thelMp`arcel]
and Parcel. Number ''a� ° y —1] W 0hv delivering a copy of the application in the
manner identified below: ))
Hand delivering a copy of the application to g(use
[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].
5igna`t -�ti'e of Appltcant
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