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HomeMy WebLinkAboutCLE201400193 Legacy Document 2014-09-29Application for Clearance pP Zonin � PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # i Date: z(, Receipt # Staff PARCEL INFORMATION �y (� 1 `yJ — 3 -- � A Tax Map and Parcel: I Existing. Zoning / /�%�y Parcel Owner: 2F2eiLs W�,at,,ile_ ��e�-C� z'40 U ' X(_-A / p_/C/ Parcel Address: A45.0 90AV1 ,5-i eye 1 ,31! City � �4` <p;� /G'f i/�G�2 State G'y7- Zip,2oZ90 (include suite or floor) PRIMARY CONTACT �e2 V L Who should we call /write concerning this project? Vl G \�1�5d Address : �� � W�1GC( �`t�L^ 11� 4.-, City C!"o2la State V14- Zip X7'.3 Office Phone: 3` &3 i 3l7 Cell # rfdk VA 9A, Fax # E -mail ddVI, /@ -r,-j Ce Pa Auf -Cy APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business �-�' l Business Name /Type: I'41 Ce V.11tt e- Sd /WM- s` Previous Business on this site yL b t1..1= 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: !' ©- / d �n_s 7e kSA4 over / Ona pan �s .!V1,w "- s%oos -if &/zo:t -je/ *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 o ave the owner's pe ission to use the space indicated on this application. I also certify that the information provided is true and accurate to e e t of y knowled e read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed / /e,7 Lf r JV 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 OfficialJ Date W ` � C ` l Zoning Official ,� " /-� Date yam' /�9 /2� 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 M ,:7 n w ; 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 N Wil ere 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 appli s Is parcel on private well r public wat)en�tform. If private well, provide He Depart Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that_ Is parcel on septi r public s er? Will 0 be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ^ J ASQ� be any new construction or renovations? If so, obtain the proper Permit. Permit # ' —1,S Z 7nninu to vomnlete the followinLy: Reviewer to complete the following: Square footage of Use: ) 7 4 p P erN / mitted as: G�r�t i �� r��, ✓ Under Section: ga. C Supplementary regulations section: Parking formula: y is �j Required spaces: S Y/ Items o be verified in the field: Inspector : Date: Notes: Violations: Y/(N If so, List: Proffers: &/N If so, List: Z,Ww e / g Variance: Y/N If so, List: SP's: Y/O If so, List: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 � 0 T 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, Zm t /LL,-, G 16.! [County application name and number] J� JJ n was provided to z / e_hs' xfh ar/ `>`r'N Z �-L" the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number -203D bcxc.��Cf - ,Sk t' 3 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 _k,"" 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 � 2. `% to the following address: Date [address; written notice mailed to the owner at the last known address of the owner as shov(m on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Sign fore of Applicant y L4 i/l c/ L— / 1 z/ f s/ Print Applicant Name !2 Date