HomeMy WebLinkAboutCLE201400185 Legacy Document 2014-09-19Application f ®r Z®ni® n Clearance
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CLE It ZQ I
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE NL ( ��
Check # Date:
Staff:
Receipt #
'PARCEL INFORMATr_I _ / q
Tax Map and Parcel: aW 60 -040 C1 Existing Zoning L.0
��C •
Parcel Owner: l owK S I e EAST,
n., 1, p
Parcel Address: a-a IVY 4 Qb , SUtf L; a' &ity CAWMI�' State V 1 � UJ(.A Zip JQq
(include suite or floor)
PRIMARY CONTACT
Who shouldj we call /write concerning this project
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Address: City( j%9r1b1)e. Ville State V�1 Zip aq
Office Phone: X20 471 Cell # - (.Q�ax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type:, g Hl11q C �S V 'TCSy — 5 T i eCk no oq 1 S
Previous Business on this site 1. Y) 16Y1D W r)
Describe the proposed business including use, number of employees number of shifts, available parking spaces, number of
vehicles, and any addi io al information that you can provide: 26 Sa/1W Fog, -6 eKPLoyw + SwFt
_g, Aix• 2-S PAMiUG SPACES .
*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 accura o the best of my kno d . I have read the conditions of approval, and I understand them, and that I will abide by them.
�_ `.Printed �1Ol�l'1a'_S
Signature]
APPROVAL INFORMATION
�C] 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 r -' Date
Zoning Official Date
Other Official Date
County of Albemarle Department of uommumry LeveiopmeuL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
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0
a
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/CN)
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 o ublic Ovate
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic o public sewer?
Y ou be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Wi ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
rJ ,. .' 4.. ..ln�n +l.o �•nllnxx�in rr•
Reviewer to complete the following:
Square footage of Use: - ? %
9/N
Permitted as: c �,
Under Section:
Supplementary regulations section:
Parking formula: �2
Required spaces: A
Y/N CJ
Items to be verified in the field:
Inspector : Date:
Notes:
VioY,L ns:
Y
Ifs st:
Proffe s:
Y/
If so, List:
Variance:
0/N
If so, List: 1UQ A91
's:
/N
If so, List:
�—
Z
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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manne identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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
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]. ,1
Singtj i ature of Applic t
Me-4&A 7 (921X(6�-
1 Print Ap licant /Name
l�
Date
f
S�.. 6
Office Space Layout 01 - Townside East
Suite 210 - HQ
43�
Office Space Layout - Townside East
Suite 2111 - Annex
I) l 0S s4.FT
Cubicle 1
Cubicle 2
Cubicle 7
Cubicle 8
Cubicle 3 C T
o a Cublcle 9
n b
f I
Cubicle 4 ".E
Cubicle 10
Cubicle 5
Cubicle 6
Kitchen
Store Room
21'
Cubicle 11
Mechanicals
Restroom
52.66'