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HomeMy WebLinkAboutCLE201400175 Legacy Document 2014-09-10Applicati ®n f ®r ZoninLy Clearance I&— PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY 9 ' l 7 J Check # ) O O 3 Date: Receipt # 9619569 Staff: PARCEL INFORMATION , n rn Tax Map and Parcel: (Q) — )ILIA 'y Existing Zoning �" s ►meJ Devvdae ! Parcel Owner: / —Ea—SL Co u r city C � �1G `GW / Parcel Address: 0SX7 8 'Rio tate VA Zip°1P17 © � (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? Address R. Wlox 9 �(o6 Ci VL6r( ►` WI�e State U -A Zip!!R uo Office Phone: Cell # 143ii- eiche,rlOti 1� eav ) le mJ)1d wo rk5 , ca APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business e -er A 1 wig S S +Y 'tail ched I P6 �s . n + V LLC Business Name /Type: 41 Previous Business on this sitelC'17t �o'rC4 (`3 C-! 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: A i e v vas l S *This Clearance will only be valic0on the parcel for which it is approved. If you change, intensify or riiove 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. II have read the conditions of approval, and understand them, and that I will abide by them. `I Signature O• ���G1i��% j�`- �i< <l�C��d�Printed� <�'L�Li--��Ui�S 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 �?T t �f 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 1-, Intake to complete the following: Y 11(�N) Is use in LI, III or PDIP zoning? Engineer's Report (CER) packet. Y / CN) If so, give applicant a Certified 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 r ublic water? If private well, provide Healt form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap Is parcel on septic 6C-public sew Y /NN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit, Permit # Y / l t er Wile be any new construction or renovations? If so, obtain the proper Permit. Permit # 7.nninv to e.mminlete the fnllowinu: Reviewer to complete the following: Square footage of Use: 1 7 /N ) •miffed as: Under Section: Z 5' ,q ,2 Supplementary regulations section: Parking formula: Required spaces: Y/ Items to be verified in the field: Inspector : Date: Notes: Violations: Y / /I`?P If s8-,list: offers: / N If so, List: Variance: Y/ If so, Est: SP's: Y/ If so, Est: 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, P [County application name and number] was provided to C �; + , 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 AZ Hand delivering a copy of the application to 0 h r -en -leIr � ,fir -nes"- A-Lq 1 [Name of the re lord owner if the record owner is a -J 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 Date to the following address: [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 Applicant Print Applicant Name (�15hs� Date