HomeMy WebLinkAboutCLE201400072 Legacy Document 2014-09-10� of ni.iu,
Application for Zonin Clearance's,` "`
CLE #
OFFICE iJ NL , f
PLEASE REVIEW ALL 3 SHEETS Check # Date: - "Y
Receipt# �' Staff:
PARCEL INFORM arcel: T1 ' -(Y) pp� �,1 ,
Tax Map and Parcel: ��(� � lL`� I lt1' j�j Existing Zoning�,`� -!! �
Parcel Owner:
Parcel Address: ?;1dWb 5rr• .41 Sd City / /,d9 .&77f4VU.4JE-State VY4— Zip �/5
(include suite or floor)
PRIMARY CONTACT project?
Who should we call /write concerning this t�
Address :
's� W C%i tf. 4tM 0-J� , City �OVTN I'SI C) ►Isc, State ZipZb/ 5
Office Phone: (_) Cell 4A- 0(4 70Fax# E -mail AA&rt" \5¢U &-E 5R@ Mki
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: `tae ►,�, S l4 LT
Previous Business on this site
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 rovide: 22 rl'1�l- .�v�Pf 2 N! //- /% Nd
#Q-T - 5 u N T oncz US `u
*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 Aaccuro e best f my owledge. I have read the conditions of approval, and I understand them, nd that I will abide by them.
Signature
Printed ��,1Z e�L j
APPROVAL INFORMATION
>] Approved as proposed [ ] Approved with conditions [ 1 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 C. Date 1E
Zoning Official 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
r C&"..
X_5
Intake to complete the following:
Y /6)
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
0/ 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 " ublic w er?
If private well, provide Heal h-Dep rtment form.
Zoning review can not begin until we receive approval from Health
Dept, FAX DATE
Circle the one that ap s
Is parcel on septic or public sewer
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
; / N
ill there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 9 J -yfq— 6:5�4) A U
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: f J 3 Y 5'
62/ N ,, L
Permitted as:
Under Section: A ✓I, &C1- G'O'P
Supplementary regulations section:
Parking formula: 7,�
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Viola cons:
Y/ O
If so, List:
Proffers:
(� /N
so, List:
]?
u
Variance:
(V / N
If so, List: '1
SP's-
Y /(b
If so, List:
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, TCxiC- A-ur
[County application name and number]
was provided to�Ds► -§ HC.� L���"� E& � the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
by delivering a copy of the application in the
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
Z-Mailing a copy of the application to I D4F)U-5 L- �3�Y►'1 �2 Z � -A�� '� '
[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 tV on 6 to the following address:
Dat
77-Z-00 wl5cc37vs,N dvc. v fl 00 T�! �SD►4D 2 ��
[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].
/A,- .
Sign — a re of Akolicl t
Ap ts R LW ko-F R-vv, V4 N
Print Applicant Name
Y Zq Zap
Date