HomeMy WebLinkAboutCLE201400197 Legacy Document 2014-10-03Application for Zoning Clearance
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CLE # - C �i�
OFFICE 'UM LY
PLEASE REVIEW ALL 3 SHEETS C
Check # Date: 1__
Receipt#-4TkM Staff:
PARCEL INFORMATION
Tax Map and Parcel: 5- GA _
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`il 1
Parcel Address: `
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Lr a I n mcQ i' Y- 1- `
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Address
Office Phone: Cell # Fax # Y3�4 193— E-maO Q f E' �1�1�1(ZYY1 . i' n at
county of A memarle llePk1X-tl11eul. vi t.vt+uuu „uy �r. ..n..,..... ..�
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/l /2011 Page 2 of3
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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/V
Will there be food preparation?
If so, give applicant a Health Departnientform.
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 ub
If private well, provide Health form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or ublic sewez
ON
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Willi re be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use:
1 /N
Permitted as:
Under Section: ° 2
Supplementary regulations section:
Parking formula:
�Dt'
Required spaces.,
Y/ -
Items to be verified in the field:
Inspector : Date:
Notes:
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Violations:
Y /OI
If so, List:
Proffers:
Y
If so, ist:
Varia e:
YIfit
If so, List:
SP's'
/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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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,
[County application name and number]
was provided to t_ee Tyik �, � �(- the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number '5(,oAQ ' (� 1- o� ( by delivering a copy of the application in the
manner identified below:
�ow ne�7
X delivering a copy of the application to t Cr-) C_ 7:\, 1 `G
[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 P _
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:
IaM o�)7A Av firllX-0- C �rc T2X-L v-) 0ak3--�,
[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].
Ign tore of Applicant
Print Applicant Name
q -;Q L�-aoi
Date