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HomeMy WebLinkAboutCLE201400196 Legacy Document 2014-10-03Application for Zoningg Clearance *,,� CLE # - h �,;r4` OFFICE US. O. LY PLEASE REVIEW ALL 3 SHEETS Check # Date: 1 Receipt # Staff- PARCEL INFORMATION �.., Tax Map and Parcel: D 3 ZOO –,60 –/O a – O /!Z .4 0 Existing Zoning L Parcel Owner: k E J–N d e-T41ye n T .5 L. / 46—' n Parcel Address: _3 'V16 eOFFE V DR City State y4 • Zip (include suite or floor PRIMARY CONTACT S / ;/ 1-16 2 Who should we call/write this project? ,concerning �b ' / Address : .300 1 ee-46N �i pe 54 IBC 300 City (� !✓ ��� State l/ "' n Zip zZ,90 Office Phone: "3 ocell # Fax # E- maZ/X 416WA It j to— kegc �. APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business �t Business Name /Type: L, U /V $4 Q u C_ + (6 t4 e? ! 1 •G A 4 0 2 5 `z L- Previous Business on this site s 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: C Q 1V -1 R t-/ c 4 a z 5 O FF-1 �,a _ S-j/e,-4 k o e _C41 916v•Re5 QNe 5 h iFT_ 2d gA21ci,+y SOA6 �-_5 3 C'- -q t? S *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 accurate o the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Sign-, Gam✓G 04 M lb", C Printed W � ©W A lz g 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 ( 0 � Zoning Official Date /0 _31; c>1 / 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 6 r" Intake to complete the following: IN s use in LI, HI or PD1P zoning? If so, give applicant a Certified Engineer's Report (CER) packet. YIN 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 u - is wat r? If private well, provide He ent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appli Is parcel on septic or AhR"ewet . YIN Will you be putting up a new sign of any kind? Sign permit. Permit # If so, obtain proper YIN Will there be any new construction or renovations? If so, obtain. the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: /,3 )Q) ))/N Permitted as: r�i f" ,P; cc., Under Section: Supplementary regulations section: Parking formula: Required spaces: YIN Items to be verified in the field: Inspector : Date: Notes: Violations: Y/6T? If so, List: Proffers: Y/M If so, ist: Variance: YIN If so, List: SP's: Y/N 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, ZO /Y I r q e r e lq f- a 1-( cx- [County application name and number] was provided to Ad k 9 1—H lle5- Al e nT-5 r L L the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number � -� 2 66 - o © -v b O 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] Oil Date V/ Mailing a copy of the application to 1498 .rAI tf P5 -�Wl e n 7-S � L L— [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 0,!,--'7- ,!,--' 7- O / 7 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]. s• Signature of Applicant Print Applicant Name Date d 71' 's w kA J "Ve U fi �C ro r� C a C�- Q � �s "Ve U �;