HomeMy WebLinkAboutCLE201400201 Legacy Document 2014-10-14Application for Zoning Clearance'
CLE # Z.O l -� 2a
i. n ....: ;
OFFICE USE ONLY
Check # 3 O % Date:
PLEASE REVIEW ALL 3 SHEETS
Receipt # 9 7 Y 4 9 Staff: —Pie
PARCEL INFORMATION
Tax Map Parcel: 05YA, Q — 60 Q 6OZ OR 0 Existing Zoning &'0E 411 OM
and
Parcel Owner:
Parcel Address: `Z2 9a 1 f✓Y /?/), , ` U "T-"�— 0 City Zif State �,T Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? �i /1✓ r% /i3 �9'�
3 Z& Co k I Z-1- Dlq i VF— a s
Address : City Lf>TI ESYI L�{state �s�f'7 Zip
Office Phone: L 92-S--y v Cell # Fax # E -mail e Cd -ma • Cd
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:
Previous Business on this site
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: ! I'1f 7-N V l J',�> Q111,
S �.' � ,/�� K/,�G- sP�� -S, � �✓� i-fiC t � r
.tea
*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 - er's permission to use the space indicated on this application. I also certify that the information provided
is true and acc to to the of J owledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
i 1
Signature Printed 6 y1Y �1� � l i �� V
APPROVAL INFORMATIO
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 '3J _Date. o
Zoning Official Date 1-621 z,
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
P 4282 Ivy Road Floor Plan*
(� Tt Leasee: Ivy Publications, I.I_C
Owner: Joseph Richmond
> I st Floor Suite A: approx 1225 sq ft
Finor Suite : approx.443 so ft**'
i — 2nd Floor Suite C: a prox 402 sq ft **
NOT UK= 1 foot
1 *All measurements are rounded to the nearest half
foot. This is not a professional architectural drawing.
** Includes 112 of hall/slairway
S
2nd Floor Suitb B> C
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Ist Floor Suite 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 /(N/
Will 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 applies
Is parcel on private well public wa i''?
If private well, provide Healffi Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel o ptic public sewer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to comDlete the following:
Reviewer to complete the following:
Square footage of Use: Z V-3
l) / N
Permitted as: 69� co,,
Under Section: 2 �- • )-
Supplementary regulations section:
Parking formula:
Required spaces: v
Y /1J
Items to be verified in the field:
Inspector • Date:
Notes:
Violations:
Y /�
If so, List:
Proff rs:
Y /1CT
If so, List:
Variance:
(b/N
If so, List:
SP's-
�`
Y/6
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,
[County application name and number]
was provided to ) 0 54,-p H 11 i UA M 6H -D ) -:S R • the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 5 1 Z - b " 0 D ' b t) A 0 by delivering a copy of the application in the
manner identified below:
V Hand delivering a copy of the application to PR ) rn Pre- V To a L t C A-1 I v f� S '
[Name of the record owner if the iecord 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 t9:,7 —Q 3F-9 l CA D
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 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].
Signature o-" Applicant I I
Print Applicant Name
/0// 0 %
Date